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J Thorac Cardiovasc Surg 2005;129:440-442
© 2005 The American Association for Thoracic Surgery
Brief Communications |
a Department of Adult Cardiovascular Surgery
b Department of Cardiology, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
Received for publication April 14, 2004; revisions received May 5, 2004; accepted for publication May 10, 2004. * Address for reprints: Ramzi Ramadan, MD, Marie-Lannelongue Hospital, 133 Ave de la Résistance, 92350 Le Plessis-Robinson, France (E-mail: ramadan.ramzi@wanadoo.fr).
| The first 20% of the full text of this article appears below. |
Chronic ischemic mitral regurgitation (IMR) is characterized by restricted leaflet closure with increased leaflet tethering caused by displaced attachment of the papillary muscle (PM).1 Generally, the posterior PM is displaced by ventricular remodeling after posterolateral myocardial infarction.2 IMR carries a significantly negative prognostic effect for cardiac mortality within 5 years, even in patients without signs of established heart failure.3
A variety of surgical techniques of repairing or replacing the mitral valve have been advocated. These techniques are generally technically demanding and necessitate opening the left side of the heart. Experimental work on ventricular remodeling through reduction of the left ventricular circumference by plication of the left ventricle (LV) can restore mitral geometry toward a normal level.4 Recently, an external device that repositions the PM has been shown to reduce IMR without compromising LV function.5
We report the first 3 cases in human subjects of chronic IMR treated by means of plication of the fibrotic infarct in the posterolateral wall of the LV simultaneously with a coronary
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