Abstract:Background
Due to ongoing left ventricular (LV) remodeling and consecutive geometric displacement of both papillary muscles, end-stage heart failure is frequently associated with relevant functional mitral regurgitation (FMR) Type IIIb. Treatment strategies of FMR and their prognostic impact are still controversial.
Case summary
We present a case of an 80-year-old patient who suffered from recurrent symptoms of congestive hea… Show more
“…Jonas Pausch та ін. повідомляють про успішні оперативні втручання з переорієнтацією папілярних м'язів через 2 роки після операції [21]. Разом з тим, ізольоване усунення мітральної недостатності у даної категорії пацієнтів призводило до незначного зворотного ремоделювання міокарда, але без покращення ФВ ЛШ [22].…”
Section: таблиця 4 провідні клінічні симптоми у обстежених пацієнтів ...unclassified
Background. Heart failure (HF) is a global public health problem worldwide [2]. The most frequent cause of severe HF is dilated cardiomyopathy (DCM) [6]. The morbidity and mortality rate are constantly growing, which indicates the presence of unresolved issues in the therapy of this nosology [3].
Aim. To determine the efficacy of alternative methods of treatment in patients with severe HF caused by DCM.
Materials and methods. A retrospective analysis of the treatment results in 86 patients with severe HF on the background of DCM during the period from 2005 to 2021. All patients were divided into three groups depending on the type of treatment: in group 1 (n=59) – the standard protocol of conservative therapy was supplemented with a course of hemosorption (HS); in group 2.1 (n=21) – left ventricular remodeling surgery was performed; in group 2.2 (n=6) – left ventricular assist device (LVAD) was implanted. During the study we analyzed patients’ clinical condition, the results of transthoracic echocardiography, complications and mortality: before treatment, by the end of in-hospital treatment and in the long-term period (12 months later). Statistical evaluation was performed using Student’s test and Pearson’s χ2 test (significance level p<0.05).
Results. After the therapy, all groups showed improvement of clinical condition of the patients by one NYHA class (p<0.05). There was an increase of left ventricular ejection fraction (LVEF) from 21.1±4.66 % to 34±2.59 % in group 1 and from 22.4±2.27 % to 35.65±5.25 % in group 2.1 (p<0.05). We also observed inverse LV remodeling with marked decrease of LV end-diastolic volume (LV EDV) and LV end-systolic volume (LV ESV) to 242.16±26.11 ml and 148.6±21.3 ml ( p<0.05) in group 1, to 228.75±20.5 ml and 141.5±17.5 ml (p<0.05) in group 2. 1 and a significant decrease in these indices in group 2.2 to 261, 2±103.56 ml (by 29.15%) and to 193±92.27 ml (by 36.23%) (p<0.05), respectively.
Conclusion. Extracorporeal and surgical methods of treatment of patients with severe HF against DCM background reliably improve their clinical condition and can be used in addition to the protocol of conservative therapy.
“…Jonas Pausch та ін. повідомляють про успішні оперативні втручання з переорієнтацією папілярних м'язів через 2 роки після операції [21]. Разом з тим, ізольоване усунення мітральної недостатності у даної категорії пацієнтів призводило до незначного зворотного ремоделювання міокарда, але без покращення ФВ ЛШ [22].…”
Section: таблиця 4 провідні клінічні симптоми у обстежених пацієнтів ...unclassified
Background. Heart failure (HF) is a global public health problem worldwide [2]. The most frequent cause of severe HF is dilated cardiomyopathy (DCM) [6]. The morbidity and mortality rate are constantly growing, which indicates the presence of unresolved issues in the therapy of this nosology [3].
Aim. To determine the efficacy of alternative methods of treatment in patients with severe HF caused by DCM.
Materials and methods. A retrospective analysis of the treatment results in 86 patients with severe HF on the background of DCM during the period from 2005 to 2021. All patients were divided into three groups depending on the type of treatment: in group 1 (n=59) – the standard protocol of conservative therapy was supplemented with a course of hemosorption (HS); in group 2.1 (n=21) – left ventricular remodeling surgery was performed; in group 2.2 (n=6) – left ventricular assist device (LVAD) was implanted. During the study we analyzed patients’ clinical condition, the results of transthoracic echocardiography, complications and mortality: before treatment, by the end of in-hospital treatment and in the long-term period (12 months later). Statistical evaluation was performed using Student’s test and Pearson’s χ2 test (significance level p<0.05).
Results. After the therapy, all groups showed improvement of clinical condition of the patients by one NYHA class (p<0.05). There was an increase of left ventricular ejection fraction (LVEF) from 21.1±4.66 % to 34±2.59 % in group 1 and from 22.4±2.27 % to 35.65±5.25 % in group 2.1 (p<0.05). We also observed inverse LV remodeling with marked decrease of LV end-diastolic volume (LV EDV) and LV end-systolic volume (LV ESV) to 242.16±26.11 ml and 148.6±21.3 ml ( p<0.05) in group 1, to 228.75±20.5 ml and 141.5±17.5 ml (p<0.05) in group 2. 1 and a significant decrease in these indices in group 2.2 to 261, 2±103.56 ml (by 29.15%) and to 193±92.27 ml (by 36.23%) (p<0.05), respectively.
Conclusion. Extracorporeal and surgical methods of treatment of patients with severe HF against DCM background reliably improve their clinical condition and can be used in addition to the protocol of conservative therapy.
“…34 Interestingly, even without coronary revascularization, durable resolution of SMR type IIIb via papillary muscle relocation might promote LV reverse remodeling and therefore improve the long-term prognosis of selected heart failure patients. 35…”
Section: Standardized Relocation Of Both Papillary Musclesmentioning
confidence: 99%
“… 34 Interestingly, even without coronary revascularization, durable resolution of SMR type IIIb via papillary muscle relocation might promote LV reverse remodeling and therefore improve the long-term prognosis of selected heart failure patients. 35 Figure 3 Standardized relocation of both papillary muscles. Exemplary intraoperative images of standardized relocation of the posteromedial papillary muscles in addition to mitral ring annuloplasty using a pledgeted 3-0 polytetrafluorethylene sutures.…”
Section: Standardized Relocation Of Both Papillary Musclesmentioning
OBJECTIVES
Papillary muscle repositioning in functional mitral regurgitation (FMR) alleviates mitral valve (MV) tenting by reducing the distance between papillary muscle tips and MV annular plane, i.e. apical left ventricular (LV) displacement. We aimed to quantify the effect of papillary muscle repositioning on papillary muscle geometry and to evaluate whether improved papillary muscle geometry after papillary muscle repositioning translates into the global LV reverse remodelling in FMR type IIIb.
METHODS
Patients with severe FMR type IIIb were prospectively enrolled and underwent pre- and postoperative 1.5-T cardiac magnetic resonance imaging. A new variable was defined, the papillary muscle to mitral annulus distance, which quantifies the distance between papillary muscle tips and MV annular plane. All parameters were measured by 2 independent investigators.
RESULTS
A total of 63 patients were enrolled. In all patients, papillary muscle to mitral annulus distance correlated significantly with established markers of LV remodelling and MV tenting severity. In patients who underwent subannular papillary muscle repositioning procedure (surgical cohort, n = 23), preoperative median papillary muscle to mitral annulus distance was 30 mm [interquartile range (IQR): 27–34 mm] and was significantly reduced postoperatively to 25 mm (IQR: 21–27 mm) (P = 0.001). LV end-diastolic diameter was reduced from 66 mm (IQR: 60–71) preoperatively to 58 mm (IQR: 53–67) after the surgery (P = 0.001).
CONCLUSIONS
MV repair with papillary muscle repositioning results in a papillary muscle to mitral annulus distance reduction and significantly improved MV tenting parameters. Improved papillary muscle geometry after papillary muscle repositioning is associated with a global LV reverse remodelling and may, thereby, improve the prognosis of FMR patients.
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