Formula-Based Relocation of the Papillary Muscle in Patients With Ischemic Mitral Regurgitation

Figure 1. (A) Measurement of the distance (green line) between the posterior papillary muscle (PPM) (red circles) and the midseptal fibrous annulus (blue circles) using 3-dimensional computed tomography. (B) Relation between estimated distance between PPM and the midseptal fibrous annulus (DP-A) calculated by the formula and the actual DP-A measured using 3-dimensional computed tomography. Box and whisker plot: The horizontal line in the middle of each box indicates the median; the top and bottom borders of the box mark the 75th and 25th percentiles, respectively, the whiskers mark minimum and maximum of all the data, and the circles indicate outliers.

Figure 2. (A) A Teflon-pledgeted CV-3 expanded polytetrafluoroethylene suture was fixed at the tip of the posterior papillary muscle (PPM) (yellow arrow). (B) A CV-3 suture was marked at the estimated distance between PPM and the midseptal fibrous annulus (DP-A) from the PPM (yellow arrow). (C) Both arms of the CV-3 suture were passed through the midseptal fibrous annulus from the left ventricular side to the left atrial side and passed through the annuloplasty ring. It was finally tied carefully at the marked point (yellow arrow). (D) Intraoperative transesophageal echocardiography demonstrated a well-functioning CV-3 suture improving leaflet tenting (yellow arrow).

Figure 3. (A) Schematic diagram shows the CV-3 suture (arrow) running inside the left ventricle. (B) Schematic diagram shows the CV-3 suture passing through the annuloplasty ring.

Figure 4. Left ventricular (LV) reverse remodeling and improved LV function at the latest follow-up (FU) at 63 (SD, 28) months (M) after surgery in 6 patients. (A) LV ejection fraction (LVEF), (B) LV end-diastolic diameter (LVEDd), and (C) LV end-systolic diameter (LVEDs). (Preop, preoperative.)