Mitral repair in patients with a ruptured papillary muscle (original) (raw)
2000, American Heart Journal
The objective of this study was to evaluate the feasibility of a modified papillary muscle repair procedure for a group of patients with ischemic mitral regurgitation when ischemia/infarction has resulted in the rupture of a papillary muscle. From January 1997 to January 1999, 843 patients underwent mitral valve surgery in our hospital. Mitral reconstruction was performed in 520 (61.7%) patients, and 6 (1.2%) of these patients were found to have a rupture of a papillary muscle at initial examination. A modified papillary muscle repair procedure to reimplant the tip of the ruptured papillary muscle "height- and/or length-adjusted" into a corresponding papillary muscle, with the use of a sandwiched pericardium pledget-reinforced polytetrafluoroethylene suture, was performed in 6 patients. Although the underlying cause in this group of patients was ischemic, concomitant coronary artery bypass grafting was performed in only 3 patients, with 1.3 grafts per patient. Of these 6 patients, 3 (50%) were men; the mean age was 60.2 +/- 12.8 years. All patients had in addition to the papillary muscle repair procedure an annuloplasty with a Carpentier-Edwards Physio-Ring. There was no early death in this group of patients. Postoperative Doppler echocardiography showed satisfactory mitral valve function in all patients and a significant postoperative ventricular remodeling: The left ventricular end-diastolic diameter decreased from 72.8 +/- 3.1 mm before surgery to 54.6 +/- 9.3 mm (P <.1) after surgery; left ventricular systolic diameter also decreased (48.5 +/- 4.9 mm vs 38. 4 +/- 9.8 mm; P <.1), and a substantial reduction of left atrial diameter (58.8 +/- 1.5 mm vs 49.7 +/- 4.1 mm; P <.1) was observed. Within the short mean follow-up period of 8.6 +/- 7.5 months (2 to 26 months), there were no late deaths, reoperations, or thromboembolic or bleeding complications. All patients were in New York Heart Association functional class I or II at the time of follow-up. Our results indicate that our modified papillary muscle reimplantation procedure is a valuable surgical tool with good survival results in patients with ischemic mitral regurgitation caused by papillary muscle rupture.
Sign up for access to the world's latest research.
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.