Abstract
Background: The key mechanism of functional mitral regurgitation (FMR) in cardiomyopathy is leaflet tethering caused by displacement of the papillary muscles (PM) due to left ventricular dilatation. The attendant remodeling process is characterized by intraventricular widening between both PM. Recently, surgical ventricular restoration (SVR) has been proposed as a technique to reduce leaflet tethering by improving ventricular geometry. However, it is unknown how SVR improve FMR. Methods and Results: From 2003 to 2010, we surgically treated FMR in 100 patients with idiopathic dilated cardiomyopahy (DCM) or ischemic cardiomyopathy (ICM). Of those, we performed posterior wall exclusion procedures by either resection (the Batista procedure, n = 13) or plication (n = 19) to approximate papillary muscle distance in a total of 32 patients (DCM in 17, ICM in 15), and these patients formed the cohort of this study. There were two 30-day mortalities (6.3%). There was no significant change in left ventricular ejection fraction, however, the size of the left ventricle, degree of MR, tethering height and distance of PM significantly decreased after operation and well maintained at the mean follow up of 3.3 ± 2.1 years. Conclusions: Posterior wall resection or plication with PM approximation provides excellent reduction of leaflet tethering and MR. Thus, reduction of PM distance may be helpful to treat FMR due to leaflet tethering.
Highlights
The key mechanism of functional mitral regurgitation (FMR) in cardiomyopathy is leaflet tethering caused by displacement of the papillary muscles (PM) due to left ventricular dilatation
There was no significant change in left ventricular ejection fraction, the size of the left ventricle, degree of MR, tethering height and distance of PM significantly decreased after operation and well maintained at the mean follow up of 3.3 ± 2.1 years
It is increasingly evident that functional mitral regurgitation (FMR) is more likely to recur or persist after mitral annuloplasty if there is severe mitral leaflet tethering in patients with idiopathic dilated cardiomyopathy (DCM) or ischemic dilated cardiomyopathy (ICM) [1]
Summary
It is increasingly evident that functional mitral regurgitation (FMR) is more likely to recur or persist after mitral annuloplasty if there is severe mitral leaflet tethering in patients with idiopathic dilated cardiomyopathy (DCM) or ischemic dilated cardiomyopathy (ICM) [1]. To date, proposed subvalvular techniques used to treat leaflet tethering include: 1) papillary muscle relocation or approximation [2,3]; 2) chordal cutting [4]; and 3) surgical ventricular restoration (SVR) [5]. Each of these techniques can play an important role in reducing leaflet tethering via different mechanisms. We performed posterior wall exclusion procedures by either resection (the Batista procedure, n = 13) or plication (n = 19) to approximate papillary muscle distance in a total of 32 patients (DCM in 17, ICM in 15), and these patients formed the cohort of this study. Reduction of PM distance may be helpful to treat FMR due to leaflet tethering
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