Repair of anterior leaflet prolapse by papillary muscle repositioning: a new surgical option Gilles D Dreyfus, MD, Toufan Bahrami, MD, Naji Alayle, MD,

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Repair of anterior leaflet prolapse by papillary muscle repositioning: a new surgical option Gilles D Dreyfus, MD, Toufan Bahrami, MD, Naji Alayle, MD, Sherban Mihealainu, MD, Claude Dubois, MD, Philippe De Lentdecker, MD The Annals of Thoracic Surgery Volume 71, Issue 5, Pages 1464-1470 (May 2001) DOI: 10.1016/S0003-4975(00)02677-1 Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Posterior papillary muscle anatomy. The three heads can be identified: anterior, medial, and posterior. The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Chordae arising from the anterior head are anchored to the anterior leaflet, chordae arising from the intermediate head are anchored to the commissural area, and those arising from the posterior head to the posterior leaflet. Elongation of chordae arising from the anterior head is usually the reason for anterior leaflet prolapses. The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Surgical techniques of papillary muscle repositioning consists of separating the anterior head from the other heads and taking it down into the left ventricle. To achieve this we make a stitch in the fibrous segment of the anterior head and tie it to the fibrous segment of the posterior head. The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Actuarial survival curve (Kaplan-Meier) (p = 0.15). (CS = chordal shortening; PMR = papillary muscle repositioning.) The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Freedom from reoperation (p = 0.62). (CS = chordal shortening; PMR = papillary muscle repositioning.) The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Event-free survival p = 0.13). (CS = chordal shortening; PMR = papillary muscle repositioning.) The Annals of Thoracic Surgery 2001 71, 1464-1470DOI: (10.1016/S0003-4975(00)02677-1) Copyright © 2001 The Society of Thoracic Surgeons Terms and Conditions