Papillary muscle approximation combined with ventriculoplasty in patients with ischemic cardiomyopathy and functional mitral regurgitation: effects on mitral valve and LV shape

Recent studies define functional mitral regurgitation (MR) and worsened left ventricular (LV) systolic indices as the widening of the dimension between papillary muscle heads; consequently, narrowing this distance may improve the mitral valve and LV function. Thirty (22 males; mean age: 57±7 years) can- didates for CABG underwent ventricu- loplasty and in 50% of them papillary muscle approximation was also per- formed (group 1). All the patients had grade 3 to grade 4 MR with an interpap- illary muscle distance of more than 2.5 cm. In group 1 the papillary muscles were drawn together by an encircling loop using a 4-mm Gore-Tex tube or umbilical tape. Mitral annuloplasty and Dor procedures were performed in all the patients. Postoperative echocardiog- raphy revealed significant changes in systolic and diastolic sphericity indices in the PMA group. There was one hos- pital death in each group, and within a short mean follow-up period of 9 months, there were no late deaths. Improvement of NYHA class and MR were significantly better in the PMA group. Papillary muscle approximation in selected patients has a clear effect on the mitral valve and LV shape by reduc- ing tethering and sphericity due to the displacement of the papillary muscles. Key Words: Ischemic mitral regurgita- tion; Papillary muscle approximation; Ventricular restoration