Effectively treating ischemic mitral regurgitation with chordal cutting in combination with ring annuloplasty and left ventricular reshaping approach

Yamamoto, Hiroyuki; Iguro, Yoshifumi; Sakata, Ryuzo; Arata, Kenichi; Yotsumoto, Goichi

doi:10.1016/j.jtcvs.2005.04.006

Cited by 23 publications

(15 citation statements)

References 5 publications

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“…We also recently demonstrated in normal ovine beating hearts the absence of negative effects of this minimal approach on segmental and global LV function evaluated invasively (elastance, preloadrecruitable stroke work, dP/dt) and noninvasively (3D LV ejection fraction (EF) and volumes, and wall motion)21. Since this technique is already being tested clinically in multiple surgical centers 22-26, it is important to test whether or not chordal cutting exacerbates long-term LV remodeling when applied to treat ischemic MR in a chronic myocardial infarction (MI), which is the purpose of this study.…”

mentioning

confidence: 99%

Relief of Mitral Leaflet Tethering Following Chronic Myocardial Infarction by Chordal Cutting Diminishes Left Ventricular Remodeling

Messas

Bel

Szymanski

et al. 2010

Circ: Cardiovascular Imaging

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confidence: 99%

Relief of Mitral Leaflet Tethering Following Chronic Myocardial Infarction by Chordal Cutting Diminishes Left Ventricular Remodeling

Messas

Bel

Szymanski

et al. 2010

Circ: Cardiovascular Imaging

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“…Residual regurgitation is often reported after restrictive annuloplasty in patients with tethering of the valve leaflets [24,[42][43][44][45][46][47]. Whilst procedures to address leaflet tethering such as chordal cutting, the Dor Procedure, papillary muscle slings and relocation have been described, these are difficult to standardise and apply [48][49][50].…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Repair or Replacement for Ischaemic Mitral Regurgitation: A Systematic Review

Rao

Murphy

Saso

et al. 2011

Heart, Lung and Circulation

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“…Several subvalvular procedures designed to reduce tethering forces in addition to MAP have been reported, including second-order chordal cutting, 5,6 papillary muscle imbrication, 21 papillary muscle sling, 22 and selective posterior papillary muscle relocation. [9][10][11][12] It is our practice to perform 1 or 2 subvalvular procedures, depending mainly on the findings of preoperative transthoracic and transesophageal echocardiography, including the configuration of the mitral leaflets, the morphology of the tethered chordae, and displacement of the papillary muscle, as well as the ventricular wall underlying it.…”

Section: Discussionmentioning

confidence: 99%

“…Chordal cutting is the division of a couple of secondary or basal chordae to make a bent leaflet reverse. 5,6 Chordal cutting was indicated in cases with a greater contribution of tethered chordae to the increased tenting height (TH) and tenting area (TA). Papillary muscle approximation attaches both papillary muscles side by side by securing a couple of sutures placed between the bodies of both papillary muscles and was performed when the interpapillary muscle distance became wider because of LV remodeling.…”

Section: Circulation Journal Vol72 November 2008mentioning

confidence: 99%

Impact of Subvalvular Procedure for Ischemic Mitral Regurgitation on Leaflet Configuration, Mobility, and Recurrence

Ueno

Sakata

Iguro

et al. 2008

Circ J

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schemic mitral regurgitation (IMR) is currently believed to mostly originate not from leaflet pathology but rather from problems with the subvalvular apparatus, including the left ventricle. Mitral annuloplasty (MAP) using an undersized ring represents the gold standard for IMR, with favorable early and intermediate postoperative outcomes. 1 However, it is still controversial whether MAP alone is enough to control mitral regurgitation (MR) at late follow-up, because of progressive left ventricular (LV) dilatation and displacement of the subvalvular apparatus. [2][3][4] In contrast to MAP, which mainly increases the coaptation zone and reduces MR at the annular level, subvalvular procedures are an etiology-based strategy to correct the subvalvular anatomical changes in IMR and thus reduce the tethering force on the mitral leaflets. Subvalvular procedures are roughly classified by their target site of the pathological subvalvular apparatus: chordal cutting, 5,6 papillary muscle approximation, 7,8 and relocation of displaced papillary muscles. [9][10][11][12] In this study, we investigated the impact of supplemental subvalvular procedures on mitral valve conCirculation Journal Vol.72, November 2008 figuration and mobility, as evaluated by leaflet angles, and on MR at mid-term follow-up. Methods PatientsFifty-nine consecutive patients with IMR who underwent surgical intervention in the past 6 years were included in this study. The patients were divided into 3 groups according to the operative procedure: MAP (M group, n=27), MAP+LV reconstruction (LV group, n=18), and MAP+ LVR+subvalvular procedure (S group, n=14). Mid-term postoperative echocardiography was completed in 26, 16, and 12 patients in the M, LV, and S groups, respectively. Our current surgical strategy for patients with ischemic heart disease is as follows.Step 1: When the patients have even a single episode of more than moderate MR, MAP with coronary artery bypass grafting (CABG) is indicated. Otherwise, the patients undergo isolated CABG.Step 2: When patients undergoing MAP have a history of previous heart failure, a LV end-diastolic volume index >90 ml/m 2 , and LV ejection fraction (EF) <40%, LVR is indicated.Step 3: When patients undergoing LVR are diagnosed as having a great contribution of the subvalvular apparatus to the increased tethering force and consequent "sea-gull" deformity of the anterior mitral leaflet (AML) on echocardiography, 1 or 2 of the subvalvular procedures are indicated.The study was approved by the institution's review board and informed consent was given by all patients. Methods and ResultsFifty-nine patients with IMR were divided into 3 groups: mitral annuloplasty (MAP) (M group, n=27), MAP+left ventricular reconstruction (LVR) (LV group, n=18), and MAP+LVR+subvalvular procedure (S group, n=14). Tenting height and area, angle between the annular line and the line connecting leaflet base to the bending-or tip-point of either the anterior or posterior leaflet, and leaflet mobility were measured echocardiographically preope...

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Effectively treating ischemic mitral regurgitation with chordal cutting in combination with ring annuloplasty and left ventricular reshaping approach

Cited by 23 publications

References 5 publications

Relief of Mitral Leaflet Tethering Following Chronic Myocardial Infarction by Chordal Cutting Diminishes Left Ventricular Remodeling

Relief of Mitral Leaflet Tethering Following Chronic Myocardial Infarction by Chordal Cutting Diminishes Left Ventricular Remodeling

Mitral Valve Repair or Replacement for Ischaemic Mitral Regurgitation: A Systematic Review

Impact of Subvalvular Procedure for Ischemic Mitral Regurgitation on Leaflet Configuration, Mobility, and Recurrence

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