Does preoperative tethering symmetry affect left ventricular reverse remodeling after restrictive annuloplasty?

Reply: The track less traveled: Subvalvular techniques and anterior leaflet augmentation in ischemic mitral regurgitation

“…1 Indeed, IMR is a disease of the left ventricle, and thus surgical repair of IMR should aim for postoperative left ventricular (LV) reverse remodeling; in its absence, mitral regurgitation (MR) can recur due to persistent LV dilation and leaflet tethering. 2 However, reverse remodeling can only occur with viable myocardium. 2 In patients with a large burden of nonviable myocardium, revascularization, although important, is likely futile in terms of substantial MR reduction, and durable mitral valve (MV) repair also is unlikely sustainable.…”

“…2 However, reverse remodeling can only occur with viable myocardium. 2 In patients with a large burden of nonviable myocardium, revascularization, although important, is likely futile in terms of substantial MR reduction, and durable mitral valve (MV) repair also is unlikely sustainable. 3 Indeed, chordal-sparing MV replacement is a more suitable option in patients with severe IMR, especially those with dilated ventricles.…”

“…1,3 RMA increases the distance between the leaflets and papillary muscles, thereby leading to persistent leaflet tethering and less durable MV repair. 2 Therefore, it is important to also assess preoperative leaflet tethering to identify patients in whom RMA would be unsuitable. 2 Leaflet tethering occurs from LV remodeling, papillary muscle displacement, and resultant increased chordal tension.…”

“…2 Therefore, it is important to also assess preoperative leaflet tethering to identify patients in whom RMA would be unsuitable. 2 Leaflet tethering occurs from LV remodeling, papillary muscle displacement, and resultant increased chordal tension. 2 Two main tethering patterns can arise: symmetric and asymmetric.…”

“…2 Leaflet tethering occurs from LV remodeling, papillary muscle displacement, and resultant increased chordal tension. 2 Two main tethering patterns can arise: symmetric and asymmetric. The former is defined by an anterior-to-posterior tethering angle ratio 0.76.…”