The Papillary Muscle Approximation Provide Stability of Mitral Valve Repair for Ischemic Mitral Regurgitation
The Papillary Muscle Approximation Provide Stability of Mitral Valve Repair for Ischemic Mitral Regurgitation
Recent publications show that an adjunctive subvalvular repair during mitral annuloplasty for
 secondary mitral regurgitation effective in preventing recurrent regurgitation. One of these
 procedures is the papillary muscles approximation. However, the safety and the positive
 impact of this method are still in doubt.
Ischemic mitral regurgitation develops in 10-50% of patients after myocardial infarction.
 Among several surgical procedures, mitral ring annuloplasty has been the method of choice for
 a considerable period. However, mitral regurgitation recurrence after surgery has a reported
 occurrence that ranges from 5% to 58%. Careful consideration of the mechanisms underlying
 recurrence of mitral regurgitation after annuloplasty might explain the unsatisfactory
 outcomes. The pathophysiology of IMR is complex and results from the imbalance between
 closing and tethering forces acting on the mitral valve. Enlargement of the left ventricular
 chamber, and displacement of papillary muscles in apical and lateral direction increase the
 tethering forces. Left ventricular and papillary muscle dyssynchrony, reduced myocardial
 contractility decrease closing forces, which lead to impaired leaflet coaptation and
 appearance of mitral regurgitation. Thus, treatment of mitral insufficiency requires an
 integrated approach affecting all units of the pathogenesis of MR recurrence.

 Recent publications show that an adjunctive subvalvular repair during mitral annuloplasty for
 secondary mitral regurgitation effective in preventing recurrent regurgitation. One of these
 procedures is the papillary muscles approximation. However, the safety and the positive
 impact of this method are still in doubt. This study is conducted to identify the positive
 qualities and safety of this technique.
Inclusion Criteria:

 -  Ischemic cardiomyopathy,

 -  Ischemic mitral regurgitation.

 Exclusion Criteria:

 -  Degenerative mitral valve disease,

 -  Unstable angina,

 -  Recent myocardial infarction (< 6 months),

 -  Papillary muscles rupture,

 -  Severe right ventricular dysfunction,

 -  Multiple organ failures,

 -  Concomitant left ventricular reconstruction,

 -  Aortic valve procedures.