Mitral Regurgitation Clinical Trial
Official title:
The Papillary Muscle Approximation Provide Stability of Mitral Valve Repair for Ischemic Mitral Regurgitation
Recent publications show that an adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation effective in preventing recurrent regurgitation. One of these procedures is the papillary muscles approximation. However, the safety and the positive impact of this method are still in doubt.
Ischemic mitral regurgitation develops in 10-50% of patients after myocardial infarction.
Among several surgical procedures, mitral ring annuloplasty has been the method of choice
for a considerable period. However, mitral regurgitation recurrence after surgery has a
reported occurrence that ranges from 5% to 58%. Careful consideration of the mechanisms
underlying recurrence of mitral regurgitation after annuloplasty might explain the
unsatisfactory outcomes. The pathophysiology of IMR is complex and results from the
imbalance between closing and tethering forces acting on the mitral valve. Enlargement of
the left ventricular chamber, and displacement of papillary muscles in apical and lateral
direction increase the tethering forces. Left ventricular and papillary muscle dyssynchrony,
reduced myocardial contractility decrease closing forces, which lead to impaired leaflet
coaptation and appearance of mitral regurgitation. Thus, treatment of mitral insufficiency
requires an integrated approach affecting all units of the pathogenesis of MR recurrence.
Recent publications show that an adjunctive subvalvular repair during mitral annuloplasty
for secondary mitral regurgitation effective in preventing recurrent regurgitation. One of
these procedures is the papillary muscles approximation. However, the safety and the
positive impact of this method are still in doubt. This study is conducted to identify the
positive qualities and safety of this technique.
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