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Surgical Relocation Of The Papillary Muscles In Ischemic Mitral Regurgitation Resulted From Excessive Remodeling
Sachiko Yamazaki, Hitoshi Yaku, Kiyoshi Doi, Kazunari Okawa, Tsunehisa Yamamoto, Suguru Ohira.
Kyoto prefectural university of medicine, Kyoto, Japan.

OBJECTIVE: The purpose of the study is to determine whether relocation of papillary muscles(PMs) to the center of the annulus of the anterior mitral leaflet(AML) as an additional procedure to undersized mitral annuloplasty (uMAP) could prevent recurrence of ischemic mitral regurgitation (IMR).
METHODS: Between 2007 and 2012, 29 patients(mean age, 67.3 ± 9.2 year) underwent relocation of PMs with CABG and uMAP. Relocation of PMs was indicated for patients with IMR when tethering height was>5mm. Relocation of bilateral PMs was performed in patients with previous anterior myocardial infarction or dilated heart.The degree of MR and LV dimensions were assessed by echocardiography preoperatively, at discharge, and during follow-up (mean 23.7 month).
RESULTS: Preoperative MR was moderate in 15 patients, moderate to severe in 9 and severe in 5. The mean LVEF was 35 ± 12 % and the LVDd, LVDs were 60 ± 7, 50 ± 9mm. Relocation of bilateral PMs was performed in 18 patients. There were 5 in-hospital deaths and 4 late deaths, none of them was related to MR. At discharge, postoperative TTE revealed zero or trace MR in all but 1 patient, who demonstrated moderate MR. During follow-up, 3 patient revealed moderate-severe MR 46.3 ± 26.8 month after surgery. In remaining patients, valve function remained stable with MR less than mild degree, even though 4 patients showed further dilatation of LV during follow-up.
CONCLUSIONS: Relocation of papillary muscles is simple and easily reproducible procedure. For patients even with continued LV remodeling, it may prevent and delay recurrence of MR.

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