J Thorac Cardiovasc Surg 2006;131:1419-1420
© 2006 The American Association for Thoracic Surgery
Effectively treating ischemic mitral regurgitation with chordal cuttling in combination with ring annuloplasty and a left ventricular reshaping approach
Murat Basaran, MD
Gata Military Training Hospital, Cardiovascular Surgery Service, Haydarpasa, Istanbul 34390, Turkey
To the Editor:
I read with great interest the case reported by Yamamoto and colleagues
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in the August 2005 issue of the Journal. In the article the authors presented a patient in whom they repaired chronic ischemic mitral regurgitation (IMR) by cutting the strut chordae of the anterior mitral leaflet, and they combined this approach with ring annuloplasty and left ventricular volume reduction surgery. The technique reported by Yamamoto and colleagues is an effective modality, but there are some concerns that should be clarified. As stated previously, IMR is a ventricular disease and not a valvular disease. Although the tethering of the mitral leaflet might play role in the development of chronic IMR, it is not the cause but rather the result of a pathophysiologic process. Chordal cutting increases leaflet coaptation area by abolishing the bending of the anterior mitral leaflet, but it does not address all underlying mechanisms of functional IMR. We also know that the underlying cause of chronic IMR might differ between individual patients. Because the underlying mechanism might differ between patient groups, the chordal cutting technique might not have the same effectiveness in all patients.
Lastly, I think that there was also a misinterpretation of the successful result. The authors used the combination of 3 different techniques, which addressed all the underlying mechanisms, but only emphasized the importance of chordal cutting. I believe that the successful result of this surgical intervention could not be attributed to only the chordal cutting procedure. Therefore the authors should comment on how they draw such a result from the data presented. Additionally, instead of chordal cutting, I also believe that the main factor for the disappearance of leaflet restriction is the left ventricular volume reduction surgery, which decreases the interpapillary distance.
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References
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- Yamamoto H, Iguro Y, Sakata R, Arata K, Yotsumoto G. Effectively treating ischemic mitral regurgitation with chordal cutting in combination with ring annuloplasty and left ventricular reshaping approach. J Thorac Cardiovasc Surg 2005;130:589-590.[Free Full Text]
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