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Echocardiography reveals that restricted leaflet motion from papillary muscle displacement drives ischemic mitral regurgitation, suggesting selective chordal cutting as a potential therapy.
Echocardiography reveals that restricted leaflet motion due to papillary muscle displacement is the fundamental mechanism of ischemic mitral regurgitation, suggesting targeted surgical approaches like selective chordal cutting.
Please see page 326 for the article by Agricola et al. ( doi:10.1016/j.euje.2004.03.001 ) to which this editorial pertains. Echocardiographic observations of leaflet motion have taught us volumes about the mechanism of valvular heart disease. Identifying excessive versus restricted mitral leaflet motion, as in Carpentier's classification, has become the foundation of repair techniques tailored to the individual patient. 1 Ischemic mitral regurgitation (MR) has nevertheless remained a therapeutic challenge, 2–6 with important failure and recurrence rates after standard annular ring reduction, 7,8 and a higher peri-operative mortality than with degenerative MR. 2–5 In ischemic MR as well, echocardiography has firmly established that restricted leaflet motion is the fundamental mechanism in the vast majority of patients, 9,10 confirming the proposal that displacement of the papillary muscles (PMs) in the remodeling heart tethers the leaflets into the ventricular cavity. 11–17 Echocardiography has provided further mechanistic clues: the anterior leaflet is deformed, with a sharp bend created near its base, at a point where intermediate (basal, secondary, or strut) chords insert; 18 this particularly limits the ability of the distal anterior leaflet to coapt with the posterior, and has suggested the therapeutic maneuver of selective chordal cutting to relieve this tethering and reduce MR, while maintaining intact chords to the leaflet margins that prevent prolapse. 19
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LEVINE et al. (2004) conducted an editorial in Ischemic mitral regurgitation. Echocardiography and selective chordal cutting was evaluated. Echocardiography reveals that restricted leaflet motion from papillary muscle displacement drives ischemic mitral regurgitation, suggesting selective chordal cutting as a potential therapy.
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