Strain balance of papillary muscles as a prerequisite for successful mitral valve repair in patients with mitral valve prolapse due to fibroelastic deficiency

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Abstract

Aims

The aim of this study was to assess the papillary muscle strain as a contributor to recurrent mitral regurgitation (MR) after mitral valve repair for fibroelastic deficiency.

Methods and results

Sixty-four patients with isolated posterior mitral valve prolapse and severe MR referred for surgery were prospectively recruited between 2008 and 2012. Two- and three-dimensional echocardiography and speckle tracking were performed in all patients. The longitudinal strain of the anterolateral (AL) and posteromedial (PM) papillary muscles was individually calculated as well as the global longitudinal strain of both papillary muscles was measured before and after mitral repair and normalized to left ventricle end-diastolic volume. Eight patients (12.5%) had at least moderate MR 6 months after mitral repair. The longitudinal strain of the AL (preop −4.94 ± 2.2 vs. postop −3.28 ± 1.3, P < 0.001) and the PM papillary muscles (preop −12.64 ± 5.3 vs. postop −4.12 ± 6.77, P < 0.001) as well as the global strain of both papillary muscles (preop −7.59 ± 3.48 vs. postop −1.07 ± 6, P < 0.001) were all reduced after surgical repair. The longitudinal strain of the PM papillary muscle was the strongest predictor of recurrent MR (when less than or equal to −14.78). The global preoperative papillary muscle strain was also a determinant of recurrent MR when the global strain was greater than −9.05% (area under the curve: 0.895, sensitivity: 100%, and specificity: 76.8%).

Conclusions

Patients with isolated posterior mitral leaflet prolapse are less likely having any residual MR post repair when the global papillary muscle strain of both papillary muscles is close or equal to zero. Strain of the papillary muscles may be an important determinant in predicting residual MR in patients who undergo mitral valve repair.

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