Left ventricular posterior wall plication for ischemic mitral regurgitation and cardiogenic shock

Ischemic mitral regurgitation, a known complication of myocardial infarction that results from left ventricular remodeling, causes heart failure and has a poor prognosis. While recent reports have revealed that surgical techniques utilizing a subvalvular or left ventricular approach might be effective in controlling mitral regurgitation, these methods are not yet established. We report the successful surgical management of a 73-year-old man who suffered from severe ischemic mitral regurgitation, experienced cardiogenic shock, and could not be weaned off mechanical support. We performed left ventriculoplasty from within the left ventricle over the mitral valve through a left atriotomy from the right side, along with coronary artery bypass grafting, ring annuloplasty, and basal chordal resection. The mitral regurgitation improved, and he finally could be weaned off mechanical support. Left ventriculoplasty might lead left ventricular reverse remodeling, improve the cardiac ejection efficiency by changing the left ventricular shape from spherical to oval, and secondarily control mitral regurgitation. Furthermore, performing left ventriculoplasty from inside the left ventricle precludes incising through the remaining healthy left ventricular myocardium, regardless of the position of the papillary muscles, and might be more effective in reducing the infarcted area responsible for ischemic mitral regurgitation.