The Journal of Thoracic and Cardiovascular Surgery
Volume 136, Issue 4 , Pages 868-875 , October 2008

Chordal translocation for ischemic mitral regurgitation may ameliorate tethering of the posterior and anterior mitral leaflets

  • Shinji Masuyama, MD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • ,
  • Akira Marui, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • ,
  • Takeshi Shimamoto, MD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • ,
  • Michihito Nonaka, MD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • ,
  • Miwako Tsukiji, MD

      Affiliations

    • Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
    • ,
  • Nozomi Watanabe, MD, PhD

      Affiliations

    • Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
    • ,
  • Tadashi Ikeda, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • ,
  • Kiyoshi Yoshida, MD, PhD

      Affiliations

    • Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
    • ,
  • Masashi Komeda, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
    • Corresponding Author InformationAddress for reprints: Masashi Komeda, MD, PhD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo, Kyoto 606-8507, Japan.

Received 18 October 2007 ,Revised 2 May 2008 ,Accepted 15 June 2008.

References 

  1. Ellis SG, Whitlow PL, Raymond RE, Schneider JP. Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention. Am J Cardiol. 2002;89:315–318
  2. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001;103:1759–1764
  3. Lamas GA, Mitchell GF, Flaker GC, Smith SC, Gersh BJ, Basta L, et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators. Circulation. 1997;96:827–833
  4. Lam BK, Gillinov AM, Blackstone EH, Rajeswaran J, Yuh B, Bhudia SK, et al. Importance of moderate ischemic mitral regurgitation. Ann Thorac Surg. 2005;79:462–470
  5. Calafiore AM, Gallina S, Di Mauro M, Gaeta F, Iaco AL, D'Alessandro S, et al. Mitral valve procedure in dilated cardiomyopathy: repair or replacement?. Ann Thorac Surg. 2001;71:1146–1153
  6. Lachmann J, Shirani J, Plestis KA, Frater RW, LeJemtel TH. Mitral ring annuloplasty: an incomplete correction of functional mitral regurgitation associated with left ventricular remodeling. Curr Cardiol Rep. 2001;3:241–246
  7. Tahta SA, Oury JH, Maxwell JM, Hiro SP, Duran CM. Outcome after mitral valve repair for functional ischemic mitral regurgitation. J Heart Valve Dis. 2002;11:11–19
  8. Messas E, Guerrero JL, Handschumacher MD, Conrad C, Chow CM, Sullivan S, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001;104:1958–1963
  9. Messas E, Yosefy C, Chaput M, Guerrero JL, Sullivan S, Menasche P, et al. Chordal cutting does not adversely affect left ventricle contractile function. Circulation. 2006;114(1 Suppl):I524–I528
  10. Messas E, Pouzet B, Touchot B, Guerrero JL, Vlahakes GJ, Desnos M, et al. Efficacy of chordal cutting to relieve chronic persistent ischemic mitral regurgitation. Circulation. 2003;108(Suppl 1):II111–II115
  11. Rodriguez F, Langer F, Harrington KB, Tibayan FA, Zasio MK, Cheng A, et al. Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function. Circulation. 2004;110(11 Suppl. 1):II115–II122
  12. Fukuoka M, Nonaka M, Masuyama S, Shimamoto T, Tambara K, Yoshida H, et al. Chordal “translocation” for functional mitral regurgitation with severe valve tenting: an effort to preserve left ventricular structure and function. J Thorac Cardiovasc Surg. 2007;133:1004–1011
  13. Otsuji Y, Handschumacher MD, Liel-Cohen N, Tanabe H, Jiang L, Schwammenthal E, et al. Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J Am Coll Cardiol. 2001;37:641–648
  14. Watanabe N, Ogasawara Y, Yamaura Y, Yamamoto K, Wada N, Okahashi N, et al. Dynamics of mitral complex geometry and functional mitral regurgitation during heart failure treatment -real-time three-dimensional echocardiographic study. J Echocardiogr. 2006;4:51–58
  15. Kuwahara E, Otsuji Y, Iguro Y, Ueno T, Zhu F, Mizukami N, et al. Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering. Circulation. 2006;114(1 Suppl):I529–I534
  16. Zhu F, Otsuji Y, Yotsumoto G, Yuasa T, Ueno T, Yu B, et al. Mechanism of persistent ischemic mitral regurgitation after annuloplasty: importance of augmented posterior mitral leaflet tethering. Circulation. 2005;112(9 Suppl):I396–I401
  17. Timek TA, Lai DT, Tibayan F, Liang D, Rodriguez F, Daughters GT, et al. Annular versus subvalvular approaches to acute ischemic mitral regurgitation. Circulation. 2002;106(12 Suppl. 1):I27–I32
  18. Langer F, Rodriguez F, Cheng A, Ortiz S, Nguyen TC, Zasio MK, et al. Posterior mitral leaflet extension: an adjunctive repair option for ischemic mitral regurgitation?. J Thorac Cardiovasc Surg. 2006;131:868–877
  19. Otsuji Y, Kuwahara E, Yuge K, Yotsumoto G, Ueno T, Nakashiki K, et al. Relation of aneurysmectomy in patients with advanced left ventricular remodeling to postoperative left ventricular filling pressure, redilatation with ischemic mitral regurgitation. Am J Cardiol. 2005;95:517–521
  20. Komeda M, Shimamoto T. Cutting secondary chordae and placing dual taut stitches between anterior mitral fibrous annulus and heads each papillary muscle can treat ischemic mitral regurgitation without deteriorating left ventricular function. J Thorac Cardiovasc Surg. 2008;135:226–227
  21. Komeda M, DeAnda A, Glasson JR, Daughters GT, Bolger AF, Nikolic SD, et al. Improving methods of chordal-sparing mitral valve replacement—Part III: optimal direction for artificial chordae. J Heart Valve Dis. 1996;5:484–490
  22. Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002;74:600–601
  23. Langer F, Rodriguez F, Ortiz S, Cheng A, Nguyen TC, Zasio MK, et al. Subvalvular repair: the key to repairing ischemic mitral regurgitation?. Circulation. 2005;112(9 Suppl):I383–I389
  24. Langer F, Schafers HJ. RING plus STRING: papillary muscle repositioning as an adjunctive repair technique for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007;133:247–249
  25. Tibayan FA, Rodriguez F, Zasio MK, Bailey L, Liang D, Daughters GT, et al. Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation. 2003;108(Suppl 1):II116–II121
  26. Starling RC, Jessup M, Oh JK, Sabbah HN, Acker MA, Mann DL, et al. Sustained benefits of the CorCap Cardiac Support Device on left ventricular remodeling: three year follow-up results from the Acorn clinical trial. Ann Thorac Surg. 2007;84:1236–1242
  27. Grossi EA, Saunders PC, Woo YJ, Gangahar DM, Laschinger JC, Kress DC, et al. Intraoperative effects of the Coapsys annuloplasty system in a randomized evaluation (RESTOR-MV) of functional ischemic mitral regurgitation. Ann Thorac Surg. 2005;80:1706–1711
  28. Rodriguez F, Langer F, Harrington KB, Tibayan FA, Zasio MK, Liang D, et al. Cutting second-order chords does not prevent acute ischemic mitral regurgitation. Circulation. 2004;110(11 Suppl. 1):II91–II97
  29. Borger MA, Murphy PM, Alam A, Fazel S, Maganti M, Armstrong S, et al. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007;133:1483–1492

PII: S0022-5223(08)01043-X

doi: 10.1016/j.jtcvs.2008.06.034

The Journal of Thoracic and Cardiovascular Surgery
Volume 136, Issue 4 , Pages 868-875 , October 2008

Article Tools

* Image Usage & Resolution