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Mitral repair in patients with a ruptured papillary muscle
Background:
The objective of this study was to evaluate the feasibility of a modified papillary muscle repair procedure for a group of patients with ischemic mitral regurgitation when ischemia/infarction has resulted in the rupture of a papillary muscle. From January 1997 to January 1999, 843 patients underwent mitral valve surgery in our hospital. Mitral reconstruction was performed in 520 (61.7%) patients, and 6 (1.2%) of these patients were found to have a rupture of a papillary muscle at initial examination.
Methods And Results:
A modified papillary muscle repair procedure to reimplant the tip of the ruptured papillary muscle "height- and/or length-adjusted" into a corresponding papillary muscle, with the use of a sandwiched pericardium pledget-reinforced polytetrafluoroethylene suture, was performed in 6 patients. Although the underlying cause in this group of patients was ischemic, concomitant coronary artery bypass grafting was performed in only 3 patients, with 1.3 grafts per patient. Of these 6 patients, 3 (50%) were men; the mean age was 60.2 +/- 12.8 years. All patients had in addition to the papillary muscle repair procedure an annuloplasty with a Carpentier-Edwards Physio-Ring. There was no early death in this group of patients. Postoperative Doppler echocardiography showed satisfactory mitral valve function in all patients and a significant postoperative ventricular remodeling: The left ventricular end-diastolic diameter decreased from 72.8 +/- 3.1 mm before surgery to 54.6 +/- 9.3 mm (P <.1) after surgery; left ventricular systolic diameter also decreased (48.5 +/- 4.9 mm vs 38. 4 +/- 9.8 mm; P <.1), and a substantial reduction of left atrial diameter (58.8 +/- 1.5 mm vs 49.7 +/- 4.1 mm; P <.1) was observed. Within the short mean follow-up period of 8.6 +/- 7.5 months (2 to 26 months), there were no late deaths, reoperations, or thromboembolic or bleeding complications. All patients were in New York Heart Association functional class I or II at the time of follow-up.
Conclusions:
Our results indicate that our modified papillary muscle reimplantation procedure is a valuable surgical tool with good survival results in patients with ischemic mitral regurgitation caused by papillary muscle rupture.
Insights
This study evaluated a modified papillary muscle repair for ischemic mitral regurgitation due to papillary muscle rupture. The procedure showed good survival and reduced ventricular dimensions in a small patient cohort.
Area of Science:
- Cardiovascular Surgery
- Cardiac Repair Techniques
- Mitral Valve Disease
Background:
- Ischemic mitral regurgitation can result from papillary muscle rupture.
- Papillary muscle rupture is a rare complication during mitral valve surgery.
- Evaluating novel repair techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the feasibility and efficacy of a modified papillary muscle reimplantation procedure.
- To evaluate the surgical outcomes in patients with ischemic mitral regurgitation and papillary muscle rupture.
- To determine the impact of the repair on ventricular remodeling and valve function.
Main Methods:
- A modified papillary muscle repair involving reimplantation of the ruptured tip was performed in 6 patients.
- The repair utilized a pericardium pledget-reinforced polytetrafluoroethylene suture.
- All patients also underwent annuloplasty with a Carpentier-Edwards Physio-Ring.
Main Results:
- No early or late deaths were observed in the 6 patients undergoing the modified repair.
- Postoperative echocardiography demonstrated satisfactory mitral valve function and significant left ventricular remodeling.
- Patients showed reduced left ventricular end-diastolic and systolic diameters, and left atrial dimensions.
Conclusions:
- The modified papillary muscle reimplantation procedure is a feasible and effective surgical option.
- This technique offers good survival rates for patients with ischemic mitral regurgitation caused by papillary muscle rupture.
- The procedure contributes to favorable ventricular remodeling and improved cardiac function.