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

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Chordal translocation for ischemic mitral regurgitation may ameliorate tethering of the posterior and anterior mitral leaflets Shinji Masuyama, MD, Akira Marui, MD, PhD, Takeshi Shimamoto, MD, Michihito Nonaka, MD, Miwako Tsukiji, MD, Nozomi Watanabe, MD, PhD, Tadashi Ikeda, MD, PhD, Kiyoshi Yoshida, MD, PhD, Masashi Komeda, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 4, Pages 868-875 (October 2008) DOI: 10.1016/j.jtcvs.2008.06.034 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic representation of CC and CT. “CT sutures” were implanted by anchoring 4-0 polypropylene sutures to each PM tip, which represents the origin of the secondary chordae, and through the midseptal annulus (saddle horn) to an external tourniquet to ensure the smooth movement of the suture. APM, Anterior papillary muscle; PPM, posterior papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 868-875DOI: (10.1016/j.jtcvs.2008.06.034) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Images of mitral apparatus on echocardiography. Annular area: area of the mitral annulus. S-L dimension: distance between the septal and lateral site of the mitral annulus. C-C dimension: distance between commeasures in the mitral annulus. Anterior/posterior PM-annulus distance: distance between the tips of anterior/posterior PM and the saddle horn. PM distance: distance between the tips of the PMs. Interpapillary angle: angle formed between the 2 lines connecting the saddle horn to the tips of the PMs. PM-annulus area: triangular area between the saddle horn and the tip of each PM. APM, Anterior papillary muscle; PPM, posterior papillary muscle; PM, papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 868-875DOI: (10.1016/j.jtcvs.2008.06.034) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Leaflet tethering of the AML and PML occurred as the result of displacement of the PMs toward the lateral site (upper right). AML tethering was reduced after the cutting of the secondary chordae, whereas PML tethering remained unchanged (lower left). Tethering of the PML and AML was reduced after CT (right lower). MR, Mitral regurgitation; LV, left ventricular. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 868-875DOI: (10.1016/j.jtcvs.2008.06.034) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions