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.

scholarly journals Impact of Papillary Muscle Relocation as Adjunct Procedure to Mitral Ring Annuloplasty in Functional Ischemic Mitral Regurgitation

Circulation ◽  
2009 ◽  
Vol 120 (11_suppl_1) ◽  
pp. S92-S98 ◽  
Author(s):  
H. Jensen ◽  
M. O. Jensen ◽  
M. H. Smerup ◽  
S. Vind-Kezunovic ◽  
S. Ringgaard ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Ring Annuloplasty

scholarly journals Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation

2020 ◽  
Vol 35 (3) ◽  
pp. 645-653
Author(s):  
Linda R. Micali ◽  
Mohammad N. Qadrouh ◽  
Orlando Parise ◽  
Gianmarco Parise ◽  
Francesco Matteucci ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Ring Annuloplasty

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.

Abstract 1104: Polymer Injection Therapy to Reverse Remodel the Papillary Muscles: Efficacy in Reducing Mitral Regurgitation in a Chronic Ischemic Model

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jorge Solis-Martin ◽  
Benjamin Johnson ◽  
J. Luis Guerrero ◽  
Mark Handschumacher ◽  
Suzanne Sullivan ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ventricular Remodeling ◽  
Systolic Function ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Papillary Muscles ◽  
Vena Contracta ◽  
Left Ventricle Remodeling

Ischemic mitral regurgitation (IMR) relates to displacement of the papillary muscles from ischemic ventricular distortion. Recurrent IMR is frequent after annuloplasty, particularly when left ventricular remodeling continues to progress. Our hypothesis is that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) polymer into the myocardium, in chronic MR with great left ventricle remodeling. Methods : we studied 8 sheep underwent ligation of circumflex branches to produce chronic ischemic MR over eight weeks. Once MR developed, PVA was injected into the myocardium underlying the infarcted PM. 2D and 3D echocardiograms were used pre infarct (baseline), pre PVA (Chronic MR) and post PVA. Hemodynamic data were obtained Results: One animal died, in the remaining 7 moderate MR developed. With PVA, the MR decreased significantly from moderate to trace-mild (vena contracta: 5.3 ± 0.9 mm vs 2.3 ± 0.9 mm, post MR vs post PVA; p<0.001). This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (33.1 ± 4.6 to 27.4±4.1 mm, post MR vs post PVA, P<0.05), tenting volume (2.1±0.3 to 1.6±0.4 mm, post MR vs post PVA, P<0.05) and leaflet area (9.4 ± 0.8 to 8.2 ± 0.7 mm, post MR vs post PVA, P<0.04). PVA was not associated with significant decreases in LVEF (41±2 % vs 39±2 %, p=ns). Conclusions : PVA polymer injections improve coaptation and reduce remodeling chronic MR without impairing LV systolic function. This new approach offers a potential alternative for relieving ischemic mitral regurgitation by correcting papillary muscle position, thus relieving tethering that causes 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

scholarly journals Is subvalvular repair worthwhile in severe ischemic mitral regurgitation? Subanalysis of the Papillary Muscle Approximation trial

2017 ◽  
Vol 153 (2) ◽  
pp. 286-295.e2 ◽  
Author(s):  
Francesco Nappi ◽  
Cristiano Spadaccio ◽  
Antonio Nenna ◽  
Mario Lusini ◽  
Massimiliano Fraldi ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation
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