scholarly journals Reply: DOES PAPILLARY MUSCLE APPROXIMATION BENEFIT BOTH THE MITRAL VALVE AND THE LEFT VENTRICLE IN THE REPAIR OF FUNCTIONAL MITRAL REGURGITATION

JTCVS Open ◽  
2021 ◽  
Author(s):  
Muralidhar Padala
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Functional Mitral Regurgitation

scholarly journals Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view

2021 ◽  
Vol 13 (1) ◽  
pp. 40-48
Author(s):  
E. G. Agafonov ◽  
M. A. Popov ◽  
D. I. Zybin ◽  
D. V. Shumakov
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Volume Overload ◽  
Left Ventricular ◽  
Functional Class ◽  
Functional Mitral Regurgitation ◽  
Admission Rates ◽  
Replacement Surgery

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation.Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation.Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.

scholarly journals Reconstructive operations on subvalvular structures of the mitral valve during remodelling of the left ventricle. Papillary muscle interventions

2020 ◽  
Vol 24 (3) ◽  
pp. 32
Author(s):  
I. I. Skopin ◽  
M. S. Latyshev
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Conflict Of Interest ◽  
Reconstruction Technique ◽  
Type Iiib ◽  
Reconstructive Operations ◽  
Reverse Remodelling ◽  
Secondary Mitral Regurgitation

<p>The optimal treatment strategy for secondary mitral regurgitation of type IIIb (A. Carpentier classification) remains debatable. The use of a standard surgical technique for treating secondary mitral regurgitation and undersized ring annuloplasty demonstrates suboptimal results in several patients (about 30% of the patients exhibit postoperative hemodynamically significant mitral regurgitation with the absence of effective reverse remodelling of the left ventricle). Such suboptimal results are associated with the unification of only the mitral valve reconstruction technique, irrespective of the state of the left ventricle (degree of dysfunction, dilatation, tethering/tenting, and papillary muscle displacement); this is not entirely justified because of the disease complexity (valve and ventricular), and it is crucial to influence both the components of the disease. Particularly, modern researchers are inclined toward the need of using additional reconstructive interventions on the subvalvular structures that contribute to a more effective reverse remodelling of the left ventricle.<br />Here, we present a review of recent studies on the surgical treatment of functional mitral insufficiency of type IIIb (A. Carpentier classification) with effects on the subvalvular structures (pupillary muscle relocation and approximation).</p><p>Revised 19 April 2020. Revised 5 May 2020. Accepted 28 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals P1689 Mitral valve prolapse secondary to ischemic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Babur Guler ◽  
A Kilicgedik ◽  
H Zencirkiran Agus ◽  
G Kahveci
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Systolic Function ◽  
Systolic Pulmonary Artery Pressure ◽  
Mitral Prolapse

Abstract Introduction Mitral valve prolapse is the most common form of degenerative mitral valve disease. However, ischemic mitral valve prolapse is a rare cause of mitral regurgitation. The mechanism was initially thought to be papillary muscle dysfunction, but more complex mechanisms were suggested recently. Purpose Try to understand the pathophysiology of ischemic mitral valve prolapse on a case example. Case Report A 42-year-old male with a history of inferoposterior myocardial infarction was admitted from outpatient clinic due to NYHA class 3 heart failure symptoms. On physical examination, a 4/6 holosystolic murmur was heard in the apex. He had a permanent pacemaker implanted for sick sinus syndrome. Transthoracic echocardiography showed 1-global dysfunction of the left ventricle (posterior segment akinetic and thinned), 2- prolapse of the posterior mitral leaflet (suspicion of ruptured chordae) 3-severe mitral regurgitation (with anterior eccentric jet), 4- moderate tricuspid regurgitation and high systolic pulmonary artery pressure (65 mmHg), 5- pacemaker lead in the right heart chambers. 6- normal right ventricular systolic function. Transesophageal echocardiography showed P2 scallop prolapse and chordae were intact, there were no redundant or myxamous components of the leaflets. It was observed that the posteromedial papillary muscle was elongated and did not contract. We commented that these echocardiographic findings represented ischemic mitral valve prolapse. Other echo findings in favour of this hypothesis were the posteromedial papillary muscle prolongation in systole and reduced the free strain of papillary muscle in the the apical long axis view. The patient underwent mitral ring anuloplasty and surgical neocord implantation. Surgery also reported the aetiology as ischemic mitral prolapse secondary to chordal extension in accordance with echocardiography. Conclusion(s): Ischemic mitral prolapse is a complex pathology involving multiple components of the mitral valve apparatus as left ventricle, papillary muscle, chordae, annulus, leaflets. The diagnostic criteria for ischemic mitral valve prolapse and its management are not defined. The presence of myocardial infarction and the exclusion of other possible valve pathologies with transesophageal echocardiography are important steps in the diagnosis. Abstract P1689 Figure.

Abstract 16874: Papillary Muscle Approximation Relieves Tethering Forces and Improves Systolic Mitral Valve Kinematics in an Ex-Vivo Model of Functional Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samantha Zhan Moodie ◽  
Kirthana Sreerangathama Suresh ◽  
Dongyang Xu ◽  
Muralidhar Padala
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ex Vivo ◽  
Functional Mitral Regurgitation ◽  
Current Standard ◽  
Ex Vivo Model ◽  
Mitral Valves ◽  
Baseline Values ◽  
Mitral Valve Geometry

Introduction: Undersizing annuloplasty (UA), which is the current standard to correct functional mitral regurgitation (FMR) is effective, but the resulting unphysiological systolic geometry causes FMR recurrence. On the other hand, papillary muscle approximation (PMA), a sub-annular technique, reduces inter-papillary separation and tethering forces, mobilizing the leaflets. Objective: To investigate the effect of PMA on mitral valve tethering forces and systolic coaptation geometry, compared to UA. Methods: A left heart model with pig mitral valves was used to create a tethered mitral valve geometry and to perform surgical repairs ( Fig. A ). Mitral valve geometry, and marginal and strut chordal forces acting on both leaflets were measured. Eight individual pig valves (n=8) were studied, with hemodynamic and mechanics data acquired at normal geometry (BASELINE) ( Fig. B) , after tethering (FMR) ( Fig. C) , undersizing annuloplasty (UA) to size 34 (Edwards Lifesciences Physio ring) ( Fig. D) , papillary muscle approximation (PMA), and combination (PMA+UA). Results: Tenting height, which increased after FMR, was least with PMA (0.46 cm± 0.21) and PMA+UA (0.50± 0.16) but remained significantly high with UA (0.73±0.21, p=0.03) ( Fig. E ). Excursion angles of anterior and posterior leaflets were restored close to baseline values after PMA and PMA+UA but remained significantly tethered after UA ( Fig. F & G ). Tethering of the valve increased the strut and marginal chordae forces from 0.47 and 0.14 N to 0.89 and 0.21 N, an increase of 89% and 50% respectively. PMA reduced the forces by 47% and 34%, and PMA+UA reducing it by 43% and 34%to 0.51 while UA only reduced it by 15% and 20% ( Fig. H & I ). Conclusion: PMA significantly reduced the tethering forces on both marginal and strut chordae of both leaflets. Decrease in tethering forces restored the physiologically favorable valve geometry enabling better leaflet mobility and coaptation compared to UA.

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