Surgical correction of posterior leaflet tethering in ischemic mitral regurgitation

Ischemic mitral regurgitation is a common complication in ischemic heart disease. It is generally accepted that intervention for the mitral valve is required if there is moderate to severe regurgitation. Generally, this would involve the placement of an annuloplasty ring or band to cinch down the dilated posterior annulus. More recently, attention has been drawn to the common problem of posterior leaflet tethering in these ischemic patients and the need to specifically address this pathology. A novel method has recently been described whereby the posteromedial papillary muscle is hitched up toward the annulus by a suture and then supported with a partially flexible annuloplasty ring. The purpose of this report is to show that this technique is easily performed and reproducible in other centres, and that it produces good short to medium term results. The report details the results achieved in six consecutive patients with at least moderate mitral regurgitation and posterior leaflet tethering.