PMID- 22111339
OWN - NLM
STAT- MEDLINE
DCOM- 20120105
LR  - 20111124
IS  - 0021-5252 (Print)
IS  - 0021-5252 (Linking)
VI  - 64
IP  - 11
DP  - 2011 Oct
TI  - [Surgical treatment for ischemic mitral regurgitation].
PG  - 968-75
AB  - BACKGROUND: Ischemic mitral regurgitation (IMR) is characterized by annular 
      dilation and restricted leaflet closure with increased leaflet tethering caused 
      by displaced attachment of the papillary muscles. Our surgical strategy for IMR 
      consists of mitral annuloplasty (MAP) and additional left ventricular restoration 
      procedures as needed. When the left ventricular dilation and mitral tethering are 
      mild, we perform MAP alone. On the other hand, we add papillary muscle 
      approximation (PMA) through left ventriculotomy with or without infero-posteiror 
      wall exclusion (the Batista procedure) when left ventricular dilatation and 
      leaflet tethering are severe. METHODS: From November 2007 to April 2011, we 
      surgically treated 19 patients with IMR at our institution. Of those, 13 patients 
      underwent MAP alone (group M) and 6 patients underwent MAP and PMA (group P). 
      RESULTS: There were no hospital deaths. Postoperatively, echocardiography showed 
      no or mild mitral regurgitation (MR) in all patients except 1 patient in group M. 
      There was significant improvement in left ventricular ejection fraction (LVEF) in 
      both groups. Moreover, left ventricular size decreased significantly in both 
      groups. In group P, the tethering height, area and papillary muscle distance also 
      decreased significantly. There were no patients who developed recurrent MR 
      postoperatively. However, in group P, there were 2 late deaths caused by 
      congestive heart failure and sepsis, and remaining 3 patients suffered from 
      congestive heart failure. In group M, there were no late deaths and all patients 
      were in New York Heart Association (NYHA) class I or II. CONCLUSION: Our surgical 
      strategy for IMR yields excellent reduction of MR. Especially the PMA provides 
      promising effect on tethering reduction. However, the absence of recurrent MR was 
      not associated with an improvement in symptoms and survival in patients who 
      presented with severe left ventricular dilatation and leaflet tethering.
FAU - Yamazaki, Kazuhiro
AU  - Yamazaki K
AD  - Department of Cardiovascular Surgery, Kyoto University Graduate School of 
      Medicine, Kyoto, Japan.
FAU - Minakata, Kenji
AU  - Minakata K
FAU - Nakahara, Takahiro
AU  - Nakahara T
FAU - Funamoto, Masaki
AU  - Funamoto M
FAU - Oda, Motoyuki
AU  - Oda M
FAU - Takai, Fumie
AU  - Takai F
FAU - Takeda, Takahide
AU  - Takeda T
FAU - Muranaka, Hiroyuki
AU  - Muranaka H
FAU - Marui, Akira
AU  - Marui A
FAU - Miwa, Senri
AU  - Miwa S
FAU - Ikeda, Tadashi
AU  - Ikeda T
FAU - Sakata, Ryuzo
AU  - Sakata R
LA  - jpn
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - Kyobu Geka
JT  - Kyobu geka. The Japanese journal of thoracic surgery
JID - 0413533
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Ischemia/surgery
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/*surgery
MH  - Treatment Outcome
EDAT- 2011/11/25 06:00
MHDA- 2012/01/06 06:00
CRDT- 2011/11/25 06:00
PHST- 2011/11/25 06:00 [entrez]
PHST- 2011/11/25 06:00 [pubmed]
PHST- 2012/01/06 06:00 [medline]
PST - ppublish
SO  - Kyobu Geka. 2011 Oct;64(11):968-75.