Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation

2002 ◽  
Vol 74 (2) ◽  
pp. 600-601 ◽  
Author(s):  
Irving L Kron ◽  
G.Randall Green ◽  
Jeffrey T Cope
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Posterior Papillary Muscle ◽  
Chronic Ischemic Mitral Regurgitation

scholarly journals Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle

2014 ◽  
Vol 2 (1) ◽  
pp. 29-31
Author(s):  
Prashanth Panduranga
Keyword(s):  
Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Rare Presentation ◽  
Clear Cut ◽  
Intracardiac Mass ◽  
Chronic Ischemic Mitral Regurgitation ◽  
Perioperative Transesophageal Echocardiography

ABSTRACT Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical implications. How to cite this article Panduranga P. Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle. J Perioper Echocardiogr 2014;2(1)29-31.

Abstract 2304: Impact of Papillary Muscle Relocation as Adjunct Procedure to Mitral Ring Annuloplasty in Functional Ischemic Mitral Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Henrik Jensen ◽  
Morten O Jensen ◽  
Morten H Smerup ◽  
Stefan Vind-Kezunovic ◽  
Steffen Ringgaard ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Papillary Muscles ◽  
Posterior Papillary Muscle ◽  
Ring Annuloplasty ◽  
Group A ◽  
Leaflet Coaptation ◽  
The Impact ◽  
3D Magnetic Resonance Imaging

The optimal surgical treatment in functional ischemic mitral regurgitation (FIMR) remains controversial. Recently, a posterior papillary muscle relocation (PMR) technique as adjunct procedure to ring annuloplasty has been proposed to prevent recurrent FIMR. We assessed the hypothesis that relocating both papillary muscles as adjunct procedure to down-sized ring annuloplasty improves mitral leaflet coaptation geometry in FIMR pigs. Eleven FIMR pigs were randomized to down-sized ring annuloplasty (RA, N=6) or RA combined with PMR (RA+PMR, N=5). In the RA+PMR group a 2– 0 Goretex suture was attached to each trigone, exteriorized through the corresponding papillary muscle, mounted on an epicardial pad and tightened to relocate the myocardium adjacent to the anterior and posterior papillary muscles 5 and 15 mm, respectively. Using 3D magnetic resonance imaging the impact from these interventions on leaflet geometry was assessed. Statistically significant (p<0.05) differences in postoperative leaflet geometry were observed at end-systole (RA vs. RA+PMR, mean ±SEM): Occlusional leaflet area (877 ±36 vs. 666 ±52 mm 2 ), tenting volume (1620 ±132 vs. 1064 ±198 mm 3 ), mean tenting height (5.9 ±0.2 vs. 4.9 ±0.3 mm), mean coaptation length (6.5 ±0.2 vs. 7.6 ±0.3 mm). Figure 1 shows coaptation length and tenting height of leaflet segments A1-P1, A2-P2 and A3-P3 at end-systole. Adding papillary muscle relocation to down-sized ring annuloplasty reduced leaflet tethering and improved coaptation geometry and therefore holds promise for reducing the prevalence of recurrent FIMR in patients.

Abstract 2832: Papillary Muscle Infarction is a Predictor of Ischemic Mitral Regurgitation: Novel Insights from Cardiac Magnetic Resonance Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thananya Boonyasirinant ◽  
Adisai Buakhamsri ◽  
Ronan Curtin ◽  
Randolph M Setser ◽  
Scott D Flamm
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Cardiomyopathy ◽  
Inverse Relationship ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Positive Correlation ◽  
Posterior Papillary Muscle ◽  
Muscle Infarction ◽  
Anterior Papillary Muscle

Introduction Ischemic mitral regurgitation (MR) bodes worsened prognosis and increased mortality in patients with ischemic cardiomyopathy. Various mechanisms of ischemic MR have been purposed, resulting in a spectrum of surgical strategies with varying success rates. Papillary muscle infarction may contribute to ischemic MR, but could not be identified non-invasively until the recent development of chronic infarction specific imaging (delayed-enhancement, or DE-MRI). Hypothesis We hypothesized that papillary muscle infarction, determined by DE-MRI, was correlated with the presence of ischemic MR. Methods Contrast-enhanced cardiac MRI for viability assessment was performed in 100 patients with ischemic cardiomyopathy (67 male, mean age 65 years). Papillary muscle infarction was determined from DE-MRI, and left ventricular (LV) functional parameters were calculated from contiguous short-axis cine-MRI images using the disc-summation technique. Results MR by echocardiography was present in 67%: 30% with mild MR (1+), 27% moderate MR (2+), and 10% severe MR (3– 4+). In patients with no, mild, moderate, and severe MR, there was a positive correlation with the prevalence of posterior papillary muscle infarction (15%, 40%, 52%, and 70%, respectively), but there was no association with anterior papillary muscle infarction (p=NS). There was a significant inverse relationship with LV ejection fraction (LVEF) (29%, 26%, 24%, and 20%, respectively). Both LVEF (p=0.013) and posterior papillary muscle infarction (p=0.006) were significantly associated with ischemic MR on univariate analysis. Using multiple logistic regression analysis, both posterior papillary muscle infarction and LVEF remained independent determinants of MR presence and severity (p<0.001 for both). Conclusions Patients with ischemic cardiomyopathy demonstrate a significant and positive correlation between the severity of MR and prevalence of posterior, but not anterior papillary muscle infarction identified by DE-MRI, and an inverse relationship with LVEF. The identification of papillary muscle infarction may provide insights into alternative approaches for repair of ischemic MR.

Outcomes of Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation

2009 ◽  
Vol 17 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Lokeswara R Sajja ◽  
Gopichand Mannam ◽  
Bhaskara R S Dandu ◽  
Satyendranath Pathuri ◽  
Sriramulu Sompalli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Ischemic Mitral Regurgitation ◽  
Valve Repair ◽  
Chronic Ischemic Mitral Regurgitation

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.

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