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J Thorac Cardiovasc Surg 2003;126:284-286
© 2003 The American Association for Thoracic Surgery

Brief communication

Restrictive mitral annuloplasty in refractory cardiogenic shock with acute postinfarction mitral insufficiency and intact papillary muscle

^a Department of Cardiothoracic Surgery, Leiden, The Netherlands

Received for publication August 26, 2002; accepted for publication October 9, 2002.

^* Address for reprints: R. A. E. Dion, MD, Leiden University Medical Center, Department of Cardiothoracic Surgery, PO Box 9600, 2300 RC Leiden, The Netherlands
r.a.e.dion@lumc.nl

The first 20% of the full text of this article appears below.

Acute severe mitral insufficiency after myocardial infarction usually results from rupture of a papillary muscle, which should be treated on an emergency basis with mitral valve repair or replacement. In the case of acute postinfarction mitral regurgitation with intact papillary muscle, no consensus exists, even with regard to the indication for surgery.

Restrictive mitral annuloplasty (RMA) has been applied in chronic ischemic mitral insufficiency, with encouraging midterm results.^1,2 In this report, we describe 2 patients in whom RMA was applied as a lifesaving procedure in the presence of refractory cardiogenic shock in postinfarction mitral insufficiency with intact papillary muscle.

Clinical summaries

PATIENT 1. A 55-year-old woman had an acute inferior wall infarction with cardiogenic shock. She received an intra-aortic balloon pump (IABP) and inotropes and was intubated. Coronary angiography revealed occlusion of the right coronary and circumflex arteries. Transesophageal echocardiography (TEE) showed grade 4 mitral insufficiency resulting from systolic restrictive motion of both leaflets (Carpentier type IIIb; Figures 1 and 2). The regurgitation jet was slightly eccentric because of the more restrictive posterior leaflet. Because of further hemodynamic deterioration, we decided to attempt correction of the mitral regurgitation as . . . [Full Text of this Article]

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				J. Braun, J. J. Bax, M. I. M. Versteegh, P. G. Voigt, E. R. Holman, R. J. M. Klautz, E. Boersma, and R. A. E. Dion Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation Eur J Cardiothorac Surg, May 1, 2005; 27(5): 847 - 853. [Abstract] [Full Text] [PDF]