Transeventricular Mitral Annuloplasty in a Patient Undergoing Partial Left Ventriculectormy

Abstract

A 70-year-old male patient with heart failure resulting from dilated cardiomyopathy underwent a partial left ventriculectomy between the papillary muscles and a newly devised transventricular mitral annuloplasty. Intraoperative transesophageal Doppler echocardiography revealed reduced ventricular dimensions and corrected mitral insufficiency with unchanged ventricular filling patterns, allowing prompt recovery despite unchanged myocardial pathology.

Ventricular Volume Reduction Procedures

“…1). While sole repair of preoperative mitral regurgitation did not replace the benefit of PLV, 19 mitral annuloplasty per se may follow the same concept by downsizing the mitral annulus at the cardiac base, a situation where PLV is not effective 20 …”

Does Repair of Mitral Regurgitation Eliminate the Need for Left Ventricular Volume Reduction?

“…We assume that reducing the mitral annulus to 25 mm with a rigid artificial ring 4 is already a reduction of the left ventricular base, which is usually over 35 mm. The present observation was made in patients undergoing Alfieri‐type mitral valvuloplasty, 8 which turned out to be insufficient in some patients and prompted us to devise transventricular annuloplasty 9 . Currently, we perform transventricular mitral annuloplasty in all patients regardless of preoperative MR since constriction of the annulus reduces MR as well as the ventricular base, which was not reduced by PLV 1 …”

Letter to Editor

“…Dr. Kawaguchi also comments that “to eliminate MR via ventriculotomy alone without additional atriotomy, we later developed and reported a transventricular mitral annuloplasty to be performed for patients with dilated mitral annulus” and quotes a reference. We must temper the enthusiasm of this comment by clarifying that this was a single case report of a patient with mild MR preoperatively; 6 clearly more data are needed before making such a broad statement.…”