TY - JOUR
T1 - A Physiological Approach to Surgery for Acute Rupture of the Papillary Muscle
AU - Spence, Paul A.
AU - Peniston, Charles M.
AU - Mihic, Niko
AU - David, Tirone E.
AU - Jabr, A. Karim
AU - Archer, Derek
AU - Salerno, Tomas A.
N1 - Funding Information:
Supported by the Medical Research Council of Canada and the Heart and Stroke Foundation of Ontario.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1986
Y1 - 1986
N2 - There is controversy regarding the optimal management of patients in whom acute papillary muscle rupture develops. This study evaluates the effect of division of the anterolateral papillary muscle on left ventricular (LV) function and compares two methods of treatment - mitral valve replacement (MVR) and mitral valve repair. Thirteen pigs were placed on cardiopulmonary bypass, and interventions were performed in an isolated beating heart preparation. LV function was assessed with a compliant intraventricular balloon at baseline, after division of the anterolateral papillary muscle (Divided), after repair of the divided papillary muscle (Repair), and finally after MVR. Division of the anterolateral papillary muscle caused a significant deterioration in LV function. Function was maintained at this level after mitral valve repair but deteriorated with MVR. Developed pressure measured at baseline was 179 ± 13 mm Hg; Divided, 148 ± 11 mm Hg (p < 0.05 versus baseline); Repair, 149 ± 15 mm Hg; and MVR, 95 ± 8 mm Hg (p < 0.05 versus Divided) at a balloon volume of 20 ml. These results suggest that LV function is impaired by papillary muscle rupture. Repair of the ruptured papillary muscle is associated with better LV function than is MVR.
AB - There is controversy regarding the optimal management of patients in whom acute papillary muscle rupture develops. This study evaluates the effect of division of the anterolateral papillary muscle on left ventricular (LV) function and compares two methods of treatment - mitral valve replacement (MVR) and mitral valve repair. Thirteen pigs were placed on cardiopulmonary bypass, and interventions were performed in an isolated beating heart preparation. LV function was assessed with a compliant intraventricular balloon at baseline, after division of the anterolateral papillary muscle (Divided), after repair of the divided papillary muscle (Repair), and finally after MVR. Division of the anterolateral papillary muscle caused a significant deterioration in LV function. Function was maintained at this level after mitral valve repair but deteriorated with MVR. Developed pressure measured at baseline was 179 ± 13 mm Hg; Divided, 148 ± 11 mm Hg (p < 0.05 versus baseline); Repair, 149 ± 15 mm Hg; and MVR, 95 ± 8 mm Hg (p < 0.05 versus Divided) at a balloon volume of 20 ml. These results suggest that LV function is impaired by papillary muscle rupture. Repair of the ruptured papillary muscle is associated with better LV function than is MVR.
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U2 - 10.1016/S0003-4975(10)61831-0
DO - 10.1016/S0003-4975(10)61831-0
M3 - Article
C2 - 3729613
AN - SCOPUS:0022549995
VL - 42
SP - 27
EP - 30
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -