Benjamin B. Peeler, MD, Irving L. Kron, MD

Slides:

Advertisements

Similar presentations

Mitral Valve Repair A. Marc Gillinov, Delos M. Cosgrove

Advertisements

Ronald C. Elkins Operative Techniques in Cardiac and Thoracic Surgery

Ischemic Mitral Regurgitation: Chordal-Sparing Mitral Valve Replacement Tirone E. David, MD Operative Techniques in Thoracic and Cardiovascular Surgery

Andrew Clarke, Graham R. Nunn, Ian A. Nicholson

Feasibility and Intermediate Term Outcome of Repair of Prolapsing Anterior Mitral Leaflets With Artificial Chordal Replacement in 152 Patients Gerald.

Papillary muscle–to–anterior annulus stitches: Another technique to prevent systolic anterior motion after mitral valve repair Samer Kassem, MD, Hicham.

Ischemic Mitral Regurgitation

Rakesh M. Suri, MD, DPhil, Thomas A. Orszulak, MD

Surgery for Aortic Valve Endocarditis

Papillary muscle sandwich plasty for ischemic mitral regurgitation: A new simple technique Susumu Ishikawa, MD, Keisuke Ueda, MD, Akio Kawasaki, MD,

Pacopexy: Restoration Procedure for Nonischemic Dilated Cardiomyopathy

Ischemic Mitral Regurgitation: Chordal-Sparing Mitral Valve Replacement Tirone E. David, MD Operative Techniques in Thoracic and Cardiovascular Surgery

Correction of Ischemic Mitral Regurgitation

Operative Techniques for Repair of Muscular Ventricular Septal Defects

Tricuspid Valve Repair Technique

Tricuspid Valve Repair for Ebstein's Anomaly

Repair of spontaneous rupture of the posterior wall of the left ventricle after mitral valve replacement Anoar Zacharias, MD Operative Techniques in.

Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse? Rakesh M. Suri, MD, DPhil, Jasmine Grewal,

Mitral annuloplasty in an infant with Barth syndrome and severe mitral insufficiency: First case report and determination of annular diameter Shu-Chien.

Mitral Annuloplasty Using A Biodegradable Annuloplasty Ring

Surgical Anterior Ventricular Restoration for Ischemic Cardiomyopathy

Repair of Congenital Mitral Valve Insufficiency

Internal Left Ventricular Reconstruction

An alternate approach to valve replacement in patients with mitral stenosis and severely calcified annulus Sameh M. Said, MD, Hartzell V. Schaff, MD

Repair Techniques for Ischemic Mitral Regurgitation

Mitral valve replacement with a calcified annulus

Antonio Maria Calafiore, MD, Michele Di Mauro, MD

Benjamin B. Peeler, MD, Irving L. Kron, MD

Remodeling the Aortic Root and Preservation of the Native Aortic Valve

Tricuspid Valve Replacement

Mitral Valve Repair A. Marc Gillinov, Delos M. Cosgrove

Repair of Postinfarction Ventricular Septal Defect

Repair of primum ASD with cleft mitral valve

Aortic Root Enlargement in the Adult

Ronald C. Elkins Operative Techniques in Cardiac and Thoracic Surgery

Dilated cardiomyopathy and functional mitral regurgitation complicated with traumatic ventricular septal defect Hisato Ito, MD, Kiyohito Yamamoto, MD,

Management of Neonatal Ebstein's Anomaly

Endocarditis with Involvement of the Aorto-Mitral Curtain

Konno Procedure (anterior aortic annular enlargement) for Mechanical Aortic Valve Replacement Hiromi Kurosawa Operative Techniques in Thoracic and Cardiovascular.

Mitral Valve Replacement With Homograft

Chordal Preservation in Mitral Valve Replacement

Papillary heads “optimization” in repairing functional mitral regurgitation Masashi Komeda, MD, PhD, Yutaka Koyama, Shunsuke Fukaya, Hideki Kitamura

Fleur de Lys Repair of Posterior Mitral Valve Leaflet

Predicting recurrent mitral regurgitation after mitral valve repair: A difficult endeavor and a necessity Denis Bouchard, MD, Louis P. Perrault, MD,

Samer Kassem, MD, Majed Othman, MD

Quick but effective surgery for functional mitral regurgitation secondary to aortic valve disease Masashi Komeda, MD, PhD The Journal of Thoracic and.

Carl L. Backer, MD, Osama Eltayeb, MD, Michael C. Mongé, MD, John M

Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation Gerald M.

Functional classification dictates type of repair in “complex” mitral insufficiency: Application to a case of a hammock mitral valve in an adult patient

A New Surgical Repair Technique for Ischemic Total Papillary Muscle Rupture Sung Kwang Lee, MD, Woon Heo, MD, Ho-Ki Min, MD, Do Kyun Kang, MD, Hee Jae.

The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly Roland Hetzer, MD, PhD, Paul Hacke, Mariano Javier, Oliver Miera,

Chordal translocation for ischemic mitral regurgitation may ameliorate tethering of the posterior and anterior mitral leaflets Shinji Masuyama, MD, Akira.

Patch Enlargement of the Aortic Annulus using the Manouguian Technique

Barlow disease: Simple and complex

Echocardiographic visualization and quantification of mitral complex during mitral repair for severe functional mitral regurgitation Kikuko Obase, MD,

A Novel Method of Leaflet Reconstruction After Triangular Resection for Posterior Mitral Valve Prolapse Rakesh M. Suri, MD, DPhil, Harold M. Burkhart,

Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve Muralidhar Padala, PhD, Lazarina Gyoneva,

Antonio Maria Calafiore, MD, Michele Di Mauro, MD

Partial left ventriculectomy for idiopathic dilated cardiomyopathy: early results and six- month follow-up Siniša Gradinac, MD, Milutin Mirić, MD, PhD,

Tricuspid Valve Repair: How I Teach It

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

Tricuspid Valve Repair for Functional Tricuspid Regurgitation

Annular or subvalvular approach to chronic ischemic mitral regurgitation? Frederick A. Tibayan, MD, Filiberto Rodriguez, MD, Frank Langer, MD, Mary K.

A New Device for Ensuring the Correct Length of Artificial Chordae in Mitral Valvuloplasty Yoshiro Matsui, MD, Yasuhisa Fukada, MD, Yuji Naito, MD, Shigeyuki.

Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: Establishing the benchmark against which percutaneous.

Chordal Replacement With Expanded Polytetrafluoroethylene Sutures in Mitral Valve Repair Tirone E. David Operative Techniques in Thoracic and Cardiovascular.

Modified Edge-to-Edge Technique for Correction of Congenital Mitral Regurgitation in Infants and Children Gang Zhang, MD, Fusheng Zhang, MD, Mei Zhu,

Intraventricular mitral annuloplasty technique for use with repair of posterior left ventricular aneurysm Igor Konstantinov, MDa, Lynda L. Mickleborough,

Simplified nonresectional leaflet remodeling mitral valve repair for degenerative mitral regurgitation Y. Joseph Woo, MD, John W. MacArthur, MD The.

Artificial mitral valve chordae replacement made simple

Presentation transcript:

Suture Relocation of the Posterior Papillary Muscle in Ischemic Mitral Regurgitation Benjamin B. Peeler, MD, Irving L. Kron, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 10, Issue 2, Pages 113-122 (June 2005) DOI: 10.1053/j.optechstcvs.2005.05.001 Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 1 Carpentier’s type I leaflet dysfunction. Mitral annular dilation results in failure of leaflet coaptation and a broad central jet of mitral regurgitation. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 2 Carpentier’s type IIIb leaflet dysfunction. Posterior displacement of the posterior papillary muscle causes tethering of the A3 and P3 segments of the mitral valve, resulting in an eccentric jet of mitral regurgitation. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 3 Ring annuloplasty. The mitral ring is sized with ring sizers measuring the intertrigonal distance (usually 26-28 mm). Ten to 12 annuloplasty sutures are generally used and are placed in horizontal mattress fashion around the mitral annulus. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 4 Ring annuloplasty (cont’d). A complete semirigid ring is used. Sutures are passed through the ring fabric at appropriate intervals to produce an even annular reduction. This results in proper coaptation of the anterior and posterior leaflets. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 5 Posterior papillary muscle relocation. Mitral repair begins with preoperative and intraoperative echocardiographic assessment of the mechanism of mitral regurgitation, confirming regurgitation secondary to type IIIb leaflet motion. The amount of leaflet tethering is estimated by intraoperative transesophageal echocardiography. With a standard left atrial approach, the head of the posterior papillary muscle is relocated anteriorly by passing both needles of a 3-0 polypropylene suture through the fibrous portion of the posterior papillary muscle tip. Unless the papillary muscle tip is particularly fibrous, a pledgetted suture is used. Each needle of the double armed 3-0 prolene is then passed up through the adjacent mitral annulus usually posterior to the right fibrous trigone at P3. The final position of the posterior papillary muscle tip is estimated by determining the point at which leaflet coaptation occurs in the plane of the mitral annulus. Mitral annuloplasty is then performed as previously described. The adequacy of repair is tested with the left ventricular saline infusion test and the repair completed by ring placement as described above, if the valve is competent. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 6 Dor procedure and relocation of the papillary muscle tip. In cases where the left ventricle is markedly enlarged, a Dor procedure is added to both stabilize the position of the papillary muscles and prevent late apical migration of the subvalvular apparatus. Surgical location of the posterior papillary muscle tip is performed through the left ventricle in these cases. The typical ventriculotomy parallel to the left anterior descending artery is made generally within the area of myocardial thinning. This is usually about 1 fingerbreadth lateral to the artery as it courses toward the apex of the heart. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 7 Dor procedure and relocation of the papillary muscle tip (cont’d). Via the left ventricular exposure, the posterior papillary muscle stitch (3-0 polypropylene) is placed first through the head of the papillary muscle and then through the adjacent posterior mitral annulus. The suture is then tied on the ventricular side. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 8 Dor procedure and relocation of the papillary muscle tip (cont’d). One or 2 concentric Fontan stitches are then placed at the border zone between viable left ventricular myocardium and scar. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 9 Dor procedure and relocation of the papillary muscle tip (cont’d). The left ventriculotomy is closed with a 3-0 polyproylene running double layer closure buttressed 2 felt strips. Operative Techniques in Thoracic and Cardiovascular Surgery 2005 10, 113-122DOI: (10.1053/j.optechstcvs.2005.05.001) Copyright © 2005 Elsevier Inc. Terms and Conditions