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J Thorac Cardiovasc Surg 2009;137:1069-1070
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr R. Dion (Genk, Belgium). Dr Flynn, I would like to congratulate you for the quality of your presentation, and the authors and friends from the Cleveland Clinic have to be commended for an original pilot study trying to elucidate the relation between wall motion abnormality and scarring and return of MR. CMR was used, which is certainly very elaborate and time-consuming; therefore, one should not underestimate the task of applying CMR and analyzing it in 29 patients.

The main finding of this study is that extensive scarring, and severe wall motion abnormality to a lesser extent because it is less significant in the region of the posterior papillary muscle, correlates with the return of MR.

My first question concerns the preoperative myocardial infarction. All 29 patients had a history of myocardial infarction. Could you specify in which coronary territory? Was it mainly in the region of the right coronary and the circumflex, as expected, and did it always correlate with the site of scarring on CMR?

Dr Flynn. Thank you for your kind comments and your good questions. First, the most predominant area of infarction was inferior, in the right coronary territory. We did not investigate whether the degree of CMR-assessed scarring correlated with the presence of myocardial ischemia. We do not have evidence on that.

Dr Dion. I ask because the LAD mean wall motion was grade 2.1. It was grade 2.3 for the RCA and the posterior papillary muscle, but it was only grade 1.6 for the circumflex and the anterior papillary muscle. So there was more wall motion abnormality in the anterior part of the heart than in the territory of the circumflex. There was also more scar in the LAD than in LCx and in the anterior papillary muscle territory, which is a bit surprising . . . [Full Text of this Article]