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) candidates
for CABG underwent ventriculoplasty
and in 50% of them papillary
muscle approximation was also performed
(group 1). All the patients had
grade 3 to grade 4 MR with an interpapillary
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 echocardiography
revealed significant changes in
systolic and diastolic sphericity indices
in the PMA group. There was one hospital
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 reducing
tethering and sphericity due to the
displacement of the papillary muscles.
Key Words: Ischemic mitral regurgitation;
Papillary muscle approximation;
Ventricular restoration