[Mitral Regurgitation Repaired by Papillary Heads Optimization Technique].

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Techniques
• Mitral Valve Repair

Background:

• Functional mitral regurgitation (FMR) increases mortality and heart failure incidence.
• Mitral valve (MV) reconstruction offers advantages over replacement, avoiding anticoagulation and preserving left ventricular function.
• Restrictive mitral valve annuloplasty alone has shown high recurrence rates for FMR.

Observation:

• Papillary heads optimization (PHO) is a reconstructive technique for FMR.
• MV repair with PHO was performed in three FMR cases: one chronic MR with tethering/dilatation, and two due to ischemic and dilated cardiomyopathy (DCM).
• Early postoperative success was achieved in all cases, but moderate MR recurred in the DCM case after 9 months.

Findings:

• Transthoracic echocardiography revealed increased distance between papillary muscle origin and posterior MV annulus in the recurrent case.
• The recurrence suggests PHO's effectiveness may be limited in the context of progressive DCM.
• Papillary muscle position correction might be overcome by DCM progression, leading to MR recurrence.

Implications:

• The PHO technique shows promise for FMR but requires careful patient selection, particularly in cases of dilated cardiomyopathy.
• Further research is needed to refine indications for PHO in DCM patients to prevent late MR recurrence.
• Optimizing surgical strategies for FMR in DCM is crucial for long-term patient outcomes.