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

2022 ◽  
Author(s):  
Kosuke Nakamae ◽  
Takashi Oshitomi ◽  
Hideyuki Uesugi
Keyword(s):  
Mitral Regurgitation ◽  
Cardiogenic Shock ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation

scholarly journals Surgical management of left ventricular posterior wall plication for cardiac shock with ischemic mitral regurgitation

2021 ◽  
Author(s):  
Kosuke Nakamae ◽  
Takashi Oshitomi ◽  
Hideyuki Uesugi
Keyword(s):  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Techniques ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Successful Case ◽  
Surgical Methods ◽  
Cardiac Shock ◽  
Oval Shape

Ischemic mitral regurgitation (IMR) is a common complication, which is accompanied by myocardial infarction, causing heart failure and leading to poor prognosis. Although several surgical techniques have been reported, certain surgical methods have not been established for treating IMR. We report a successful case of left ventricular posterior wall plication through a left atriotomy over the mitral valve for IMR in a patient who experienced cardiac shock and could not be weaned off mechanical support. Posterior wall plication changed the left ventricle from a spherical to an oval shape, restored the position of papillary muscles and posterior wall, improved leaflet tethering, and prevented further remodeling of the left ventricle. This method may be useful for treating IMR and improve patients’ prognosis.

scholarly journals Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

2017 ◽  
Vol 190 (01) ◽  
pp. 42-50 ◽  
Author(s):  
Christiane Bretschneider ◽  
Hannah-Klara Heinrich ◽  
Achim Seeger ◽  
Christof Burgstahler ◽  
Stephan Miller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Papillary Muscle ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Chronic Myocardial Infarction ◽  
End Diastolic Volume ◽  
Significant Difference

Objective Ischemic mitral regurgitation is a predictor of heart failure resulting in increased mortality in patients with chronic myocardial infarction. It is uncertain whether the presence of papillary muscle (PM) infarction contributes to the development of mitral regurgitation in patients with chronic myocardial infarction (MI). The aim of the present study was to assess the correlation of PM infarction depicted by MRI with mitral regurgitation and left ventricular function. Methods and Materials 48 patients with chronic MI and recent MRI and echocardiography were retrospectively included. The location and extent of MI depicted by MRI were correlated with left ventricular function assessed by MRI and mitral regurgitation assessed by echocardiography. The presence, location and extent of PM infarction depicted by late gadolinium enhancement (LGE-) MRI were correlated with functional parameters and compared with patients with chronic MI but no PM involvement. Results PM infarction was found in 11 of 48 patients (23 %) using LGE-MRI. 8/11 patients (73 %) with PM infarction and 22/37 patients (59 %) without PM involvement in MI had ischemic mitral regurgitation. There was no significant difference between location, extent of MI and presence of mitral regurgitation between patients with and without PM involvement in myocardial infarction. In 4/4 patients with complete and in 4/7 patients with partial PM infarction, mitral regurgitation was present. The normalized mean left ventricular end-diastolic volume was increased in patients with ischemic mitral regurgitation. Conclusion The presence of PM infarction does not correlate with ischemic mitral regurgitation. In patients with complete PM infarction and consequent discontinuity of viable tissue in the PM-chorda-mitral valve complex, the probability of developing ischemic mitral regurgitation seems to be increased. However, the severity of mitral regurgitation is not increased compared to patients with partial or no PM infarction. Key points  Citation Format

Mitral tetrahedron as a geometrical surrogate for chronic ischemic mitral regurgitation

2005 ◽  
Vol 289 (3) ◽  
pp. H1218-H1225 ◽  
Author(s):  
Hsi-Yu Yu ◽  
Mao-Yuan Su ◽  
Yih-Sharng Chen ◽  
Fang-Yue Lin ◽  
Wen-Yih Isaac Tseng
Keyword(s):  
Mitral Regurgitation ◽  
Surface Area ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Area Index ◽  
Ventricular Ejection Fraction ◽  
Cutoff Values ◽  
Chronic Ischemic Mitral Regurgitation

The present study tests the hypothesis that a mitral tetrahedron (MT) is a useful geometrical surrogate for assessment of chronic ischemic mitral regurgitation (CIMR). Fifty-eight subjects were divided into three groups on the basis of left ventricular ejection fraction (LVEF) and the presence or absence of CIMR: LVEF ≥0.5 and negative CIMR ( group 1, n = 28), LVEF <0.5 and negative CIMR ( group 2, n = 12), and LVEF <0.5 and positive CIMR ( group 3, n = 18). MT was defined by its four vertices at the anterior annulus, posterior annulus, and medial and lateral papillary muscle roots, determined by MRI at peak systole. The results showed no clear cutoff values of MT parameters between groups 2 and 1. In contrast, all MT indexes were significantly different between groups 3 and 2 ( P < 0.05), and significant cutoff values differentiated the two groups. A scoring system employing parameters of the whole MT confirmed the absence of CIMR with total edge length index <268 mm/BSA1/3, total surface area index <2,528 mm2/BSA2/3, and volume index <5,089 mm3/BSA (where BSA is body surface area). The sensitivity, specificity, and positive and negative predictive values were 1.00. This preliminary study demonstrates that MT might serve as a good geometrical surrogate for assessing CIMR. The derived geometrical criteria of MT may be useful in surgical correction of CIMR.

Abstract 15934: Refractory Cardiogenic Shock in a Patient With Hypertrophic Obstructive Cardiomyopathy and Mitral Regurgitation Necessitating Intra-Aortic Balloon Pump Use

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Indrajeet Mahata ◽  
Michael Faulx ◽  
Snigdha kola ◽  
Sweta Singh
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiogenic Shock ◽  
Pulmonary Edema ◽  
Muscle Protein ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Afterload Reduction ◽  
Intra Aortic Balloon Pump ◽  
Refractory Cardiogenic Shock

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disease due to a mutation in cardiac muscle protein resulting in left ventricular wall and septal hypertrophy. The presence of systolic anterior motion (SAM) of the mitral valve leads to dynamic left ventricular outflow tract (LVOT) obstruction. With increasing SAM of the anterior mitral leaflet there is resultant loss of coaptation leading to mitral regurgitation (MR). MR has been associated with HOCM but severe MR physiology causing refractory cardiogenic shock and requiring the use of afterload reduction through intra-aortic balloon pump (IABP) is rare and seems paradoxical to the conventional therapy for HOCM. Case summary: This is a case of 71year old female with HOCM, presenting with worsening shortness of breath. She had pulmonary vascular congestion on Chest X-ray and her Transthoracic Echocardiography demonstrated significant LVOT obstruction with moderate MR. She was being evaluated for myomectomy while being treated medically with beta blocker therapy for HOCM. She decompensated with acute respiratory failure from pulmonary edema, her blood pressure and oxygen saturation dropped. She was intubated. Swan- ganz catheter reading suggested wedge pressures of 22 and elevated pulmonary pressures. MvO2 was 32% and this was suggestive of cardiogenic shock. The Trans-esophageal echocardiogram (TEE) showed normal EF with severe concentric LVH and a moderate to severe (3+) MR due to restricted leaflet motion with regurgitant orifice area being 2.5cm2. At that point her MR was the dominant physiology behind her acute decompensation and cardiogenic shock and hence an IABP was placed for reducing afterload that helped in stabilizing her. Subsequently her wedge pressure and MvO2 improved, she was weaned off the IABP and extubated. The patient is being evaluated for myomectomy and mitral valve repair. Conclusion: This case illustrates complex hemodynamics and a challenging management due to competing MR and HOCM physiologies, too much central volume to offset HOCM may worsen MR and pulmonary edema while too much afterload reduction might worsen the HOCM. The use of IABP in a HOCM patient though seems paradoxical but was necessary in this setting to deal with complex physiologies.

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