Multicomponent mitral valve reconstruction with papillary muscles suspension to the mitral annulus for ischemic mitral insufficiency type IIIb

Objective Pathophysiological background of type IIIb functional mitral regurgitation (FMR) is a progressively increasing distance between papillary muscle tips and mitral annular plane. Standard surgical treatment of such FMR by means of undersized mitral annuloplasty is associated with a high recurrence rate. Methods We propose a modified subannular maneuver to correct type IIIb FMR while combining undersized annuloplasty with a controlled realignment of both papillary muscles, thereby fixing the distance between mitral annular plane and papillary muscle tips. The differences of this subannular maneuver as compared with the previously published techniques are the following: (1) controlled realignment of both papillary muscles, (2) fixation of the papillary muscles to mitral annulus distance on an annuloplasty ring, and (3) application in a three-dimensional endoscopic minithoracotomy setting. Results We describe a surgical technique of minimally invasive mitral valve repair performed due to severe type IIIb FMR, which includes a modified subannular maneuver to realign both papillary muscles. Preliminary results of the first 10 patients who underwent this procedure at our institution are presented. There was no in-hospital mortality and follow-up echocardiography (mean ± SD echocardiographic follow-up = 10 ± 6 months) demonstrated stable functional results. Conclusions Our initial experience indicates that adding of this subannular maneuver to the standard annuloplasty and thereby fixing the distance between papillary muscles and mitral annular plane have a potential to improve results of surgical FMR treatment.

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Early experience with mitral valve reconstruction for mitral insufficiency

The American Journal of Surgery ◽

10.1016/0002-9610(91)90900-x ◽

1991 ◽

Vol 161 (5) ◽

pp. 563-566

Author(s):

Albert H. Krause ◽

J.Edward Okies ◽

John C. Bigelow ◽

U.Scott Page ◽

Mark T. Metzdorff ◽

...

Keyword(s):

Mitral Valve ◽

Early Experience ◽

Mitral Insufficiency ◽

Mitral Valve Reconstruction ◽

Valve Reconstruction

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Improved clinical results due to the use of a semirigid partial annuloplasty band as an alternative for flexible annuloplasty rings and bands for mitral valve reconstruction

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1038033 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

U Rosendahl ◽

A Albert ◽

S Bauer ◽

J Ennker

Keyword(s):

Mitral Valve ◽

Clinical Results ◽

Mitral Valve Reconstruction ◽

Valve Reconstruction

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A Complex Mitral Valve Reconstruction: A Case Report

The Heart Surgery Forum ◽

10.1532/hsf.648 ◽

2005 ◽

Vol 6 (2) ◽

pp. 27

Author(s):

Dimitrios Buklas ◽

Massimo Massetti ◽

Eric Saloux ◽

Eugenio Neri ◽

Olivier LePage ◽

...

Keyword(s):

Mitral Valve ◽

Surgical Techniques ◽

Mitral Valve Insufficiency ◽

Left Ventricular ◽

Mitral Valve Reconstruction ◽

Mitral Repair ◽

Valve Reconstruction ◽

Valve Insufficiency ◽

Valve Function ◽

Valvular Function

Several techniques are currently in use for mitral valve reconstruction. We report a mitral repair case in which the use of a combination of different surgical techniques resulted in the necessary correction. A 47-year-old woman underwent surgical intervention to treat severe mitral valve insufficiency due to A1/A2/A3 and P2 prolapsed valve tissue. A combination of quadrangular resection, sliding leaflet, single chordal transposition, "flip-over" leaflet, and ring annuloplasty techniques were applied, and postsurgical correct valve function was documented by results of a left ventricular saline filling test and transesophageal echocardiography control. Complex mitral valve repairing techniques can be combined to reestablish valvular function.

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