Clinical Implications of Preserving Subvalvular Apparatus During Mitral Valve Replacement for Acute Ischemic Papillary Muscle Rupture

Cannière, Didier De; Vandenbossche, Jean Luc; Nouar, Elias; Faict, Sebastian; Falchetti, Alessandro; Unger, Philippe

doi:10.1016/j.athoracsur.2015.06.121

Cited by 9 publications

(11 citation statements)

References 5 publications

(1 reference statement)

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“…Acute mitral regurgitation necessitating immediate surgery due to complete or sequential papillary muscle (PM) rupture is a rare major adverse cardiac event [2,3]. In the majority of patients, ischemic mitral regurgitation develops gradually due to remodeling of the ischemic myocardium and altered hemodynamic conditions in the left ventricle [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Bretschneider

Heinrich

Seeger

et al. 2017

Fortschr Röntgenstr

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This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.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 enddiastolic volume was increased in patients with ischemic mitral regurgitation. ConclusionThe 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.

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Section: Introductionmentioning

confidence: 99%

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Bretschneider

Heinrich

Seeger

et al. 2017

Fortschr Röntgenstr

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“…A complete "chordal sparing" of one or both leaflets, which preserves the whole leaflet and associated first-and second-order chordae, has been described. As an alternative, partial "chordal sparing" provides an excision of a portion of the leaflet, preserving only third-order chordae (fixed to the annulus) (20). In PMR patients, a rare risk related to leaflet preservation is "sequential" PMR due to the traction and tearing at the remainder PM.…”

Section: Expositionmentioning

confidence: 99%

“…The PMR is localized by an aortotomy and the help of an endoscopic 5 mm camera, the suture is passed through the fibrous part of the ruptured PM to improve its exposition. The chordae are then cut to resolve and remove it (20).…”

Section: Expositionmentioning

confidence: 99%

Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction

Massimi¹,

Matteucci²,

Kowalewski³

et al. 2022

Ann Cardiothorac Surg

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Severe mitral regurgitation secondary to papillary muscle rupture is one of the mechanical complications after an acute myocardial infarction. Surgical strategies represent the cornerstone of treatment in this disease; in addition to surgical valve replacement, approaches involving surgical valve repair have been reported over time in different clinical scenarios to restore valve competency, improve cardiac function and reduce mechanical prosthesis-related risks. Moreover, in recent years, percutaneous trans-catheter procedures have emerged as an important alternative in high risk or inoperable patients.

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“…Український журнал серцево-судинної хірургії 2020 1 (38) ішемічна хвороба серця шення ступеня регургітації, якщо обмежитися тільки реваскуляризацією міокарда [4]. Сучасні рекомендації наголошують на проведенні хірургічного втручання пацієнтам із тяжкою ішемічною мітральною недостатністю, незважаючи на те що вони перебувають на оптимальній фармакологічній терапії серцевої недостатності [5].…”

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The Condition of the Coronary Arteries in Patients with Ischemic Mitral Insufficiency

Руденко

Potashev

Руденко

et al. 2020

ujcvs

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Secondary (or functional) mitral regurgitation is the result of myocardial dysfunction due to ischemic injury with relatively normal cusps. In patients with ischemic mitral insufficiency, only surgical coronary artery bypass grafting can affect the reverse remodeling of the left ventricle and reduce the degree of mitral regurgitation. One of the main pathogenetic factors for the development of this type of mitral insufficiency is myocardial ischemia. Studying the state of coronary blood flow in patients with ischemic mitral insufficiency is a primary task in the surgical treatment of this pathology. The aim. To study the condition of the coronary arteries in patients with ischemic mitral insufficiency. Material and methods. From January 2015 to December 2019, 194 patients with ischemic mitral insufficiency underwent surgical intervention at the Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine. Results and Discussion. Coronarography revealed haemodynamically significant coronary artery stenosis in 190 (97.9%) patients. In 4 (2.1%) patients there was no hemodynamically significant coronary arteries stenosis. Analysis of the data of selective angiography showed that the majority of patients with ischemic mitral insufficiency had three-vessel disease (75.2%). Occlusion of the left circumflex coronary artery was observed in 33 (17.4%), and sub-occlusive changes were detected in 3 (1.6%) of patients. A completely different lesion pattern is observed for the branches of the right coronary artery. Thus, in 56 (29.4%) cases, occlusion of a particular branch was found on angiogram. Sub-occlusion of the right coronary artery was observed in 15 (7.9%) cases. Conclusions. In patients with ischemic mitral insufficiency, hemodynamically significant stenosis was most often observed in the anterior interventricular artery (81.6%). Comparison of the status of the right coronary artery and circumflex artery showed that the right coronary artery lesions occurred more frequently. The section of the right coronary artery between the outflow of the acute marginal branch and the branching to the posterior interventricular and lateral branches was the most vulnerable site of the coronary bed, where the frequency of occurrence of critical stenosis was 28.4%.

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Clinical Implications of Preserving Subvalvular Apparatus During Mitral Valve Replacement for Acute Ischemic Papillary Muscle Rupture

Cited by 9 publications

References 5 publications

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction

The Condition of the Coronary Arteries in Patients with Ischemic Mitral Insufficiency

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