Related Experiment Video
Updated: Jun 20, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Papillary muscle suspension concomitant with approximation for functional mitral regurgitation
Yasushige Shingu1, Satoshi Yamada, Tomonori Ooka
1Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan. y.shingu@nifty.com
Circulation Journal : Official Journal of the Japanese Circulation Society
|September 12, 2009
Summary
Papillary muscle suspension (PMS) helps maintain mitral geometry after surgery for functional mitral regurgitation. Anterior-directional suspension is superior for diastolic mitral filling compared to posterior-directional suspension.
Area of Science:
- Cardiovascular Surgery
- Cardiac Mechanics
- Mitral Valve Disease
Background:
- Functional mitral regurgitation (MR) is often treated with mitral annuloplasty and papillary muscle approximation (PMA).
- Papillary muscle suspension (PMS) is a technique used adjunctively to preserve mitral complex geometry.
Purpose of the Study:
- To evaluate the early impact of papillary muscle suspension (PMS) on postoperative mitral geometry.
- To assess the effect of PMS on diastolic mitral tethering in patients with functional MR.
Main Methods:
- Retrospective analysis of 22 patients with left ventricular dysfunction and functional MR undergoing mitral annuloplasty and PMA with or without PMS.
- Echocardiographic measurement of submitral apparatus geometry, including papillary muscle and mitral inflow angles.
- Comparison between anterior-directional and posterior-directional suspension groups.
Main Results:
- Anterior-directional suspension resulted in significantly larger papillary muscle and mitral inflow angles compared to posterior-directional suspension (P=0.017 and P<0.001, respectively).
- These angles in the anterior group were comparable to normal controls.
- Two patients in the posterior-directional suspension group exhibited a higher transmitral pressure gradient and persistent restrictive mitral filling postoperatively.
Conclusions:
- Anterior-directional papillary muscle suspension is associated with improved diastolic mitral filling compared to posterior-directional suspension.
- This technique may help prevent left ventricular remodeling-induced mitral tethering.
Related Concept Videos
01:27Mitral Valve Prolapse I: Introduction
IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
01:20Mitral Regurgitation I: Introduction
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
01:25Mitral Regurgitation III: Medical Management
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
01:22Mitral Valve Prolapse II: Assessment and Management
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
01:28Mitral Regurgitation IV: Nursing Management
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
01:23Mitral Regurgitation II: Clinical Features and Diagnostic Tests
Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...