Mitral repair in patients with a ruptured papillary muscle

Background The objective of this study was to evaluate the feasibility of a modified papillary muscle repair procedure for a group of patients with ischemic mitral regurgitation when ischemia/infarction has resulted in the rupture of a papillary muscle. From January 1997 to January 1999, 843 patients underwent mitral valve surgery in our hospital. Mitral reconstruction was performed in 520 (61.7%) patients, and 6 (1.2%) of these patients were found to have a rupture of a papillary muscle at initial examination. Methods and results A modified papillary muscle repair procedure to reimplant the tip of the ruptured papillary muscle “height- and/or length-adjusted” into a corresponding papillary muscle, with the use of a sandwiched pericardium pledget-reinforced polytetrafluoroethylene suture, was performed in 6 patients. Although the underlying cause in this group of patients was ischemic, concomitant coronary artery bypass grafting was performed in only 3 patients, with 1.3 grafts per patient. Of these 6 patients, 3 (50%) were men; the mean age was 60.2 ± 12.8 years. All patients had in addition to the papillary muscle repair procedure an annuloplasty with a Carpentier-Edwards Physio-Ring. There was no early death in this group of patients. Postoperative Doppler echocardiography showed satisfactory mitral valve function in all patients and a significant post-operative ventricular remodeling: The left ventricular end-diastolic diameter decreased from 72.8 ± 3.1 mm before surgery to 54.6 ± 9.3 mm (P < .1) after surgery; left ventricular systolic diameter also decreased (48.5 ± 4.9 mm vs 38.4 ± 9.8 mm; P < .1), and a substantial reduction of left atrial diameter (58.8 ± 1.5 mm vs 49.7 ± 4.1 mm; P < .1) was observed. Within the short mean follow-up period of 8.6 ± 7.5 months (2 to 26 months), there were no late deaths, reoperations, or thromboembolic or bleeding complications. All patients were in New York Heart Association functional class I or II at the time of follow-up. Conclusions Our results indicate that our modified papillary muscle reimplantation procedure is a valuable surgical tool with good survival results in patients with ischemic mitral regurgitation caused by papillary muscle rupture.