Reducing the posterior wall length by using a small endoventricular patch for ischemic mitral regurgitation

Abstract

Clinical Summaries PATIENT 1. A 58-year-old man was referred to our institution for ischemic heart disease. Coronary angiography revealed a severe 3-vessel disease. Echocardiography demonstrated a moderate mitral regurgitation and a localized posterior basal aneurysm. The anterior wall motion was normal, and the cause of mitral regurgitation was leaflet tethering 10 mm in depth, mainly in the posterior leaflet retracted by the posterior papillary muscle (Figure 1, A). At the time of surgical intervention with cardiopulmonary bypass, the aorta was clamped, and cardioplegic arrest was obtained. The left ventriculotomy was made through the aneurysm parallel to the posterior descending artery. The endocardial boundary between the infarction and the normal myocardium was distinct, and the orifice of the aneurysm was 3 4 cm in size. The posterior papillary muscle was not involved in the infarction. A 2 3–cm triangular woven Dacron patch (Hemashield patch, Boston Scientific) was sutured to the mitral annulus cranially, to the posterior wall laterally, and to the septum medially with 4-0 polypropylene (Prolene, Ethicon) sutures. The ventriculotomy was closed with 3-0 polypropylene (Prolene) sutures. The left atrium was opened, and a mitral annuloplasty ring (Physio-ring, 26 mm, Edwards Lifesciences) was sutured to the annulus. Echocardiography 2 weeks (Figure 1, B) and 4 months (Figure 1, C) after surgical intervention revealed no mitral regurgitation and no leaflet tethering, and the patient is asymptomatic. PATIENT 2. An 80-year-old man was referred for ischemic mitral regurgitation. The left ventriculogram showed a localized posterior basal aneurysm with an orifice of 4 6 cm and normal anterior wall motion. Preoperative echocardiography demonstrated tethering of the posterior mitral leaflet, and the depth of tethering was 10 mm. He was treated surgically with a small endoventricular patch, 3 5 cm in size, and mitral annuloplasty. Postoperative echocardiography 2 years after the operation showed only trivial mitral regurgitation.