HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Pocar Andrea Moneta Pino Fundarò Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pocar, M. Articles by Fundarò, P. Search for Related Content PubMed Articles by Pocar, M. Articles by Fundarò, P. Related Collections Valve disease Related Article

Ann Thorac Surg 2006;81:786-787
© 2006 The Society of Thoracic Surgeons

---

Correspondence

Reply

^a Cattedra di Cardiochirurgia, Università degli Studi di Milano, Policlinico MultiMedica, Milan, Italy
^b Dipartimento Cardiologico "A. De Gasperis", Ospedale Niguarda Ca' Granda, Milano, Italy

To the Editor:

We appreciate the interest of Drs Izumoto and Kawazoe [1] in our "posterior mitral valve restoration" technique to treat mitral insufficiency after inferior myocardial infarction [2]. We apologize for not including their previous contribution in our discussion. Admittedly, their approach is strikingly similar from a technical standpoint.

However, the underlying pathophysiology is entirely different: the authors treated rheumatic posterior mitral leaflet restriction in two instances, either with one or two leaflet detachments, respectively, in the P1-P2 and P2-P3 areas. We applied this strategy to compensate the loss of leaflet coaptation caused by postinfarction asymmetric tethering of the mitral apparatus toward the left ventricle and a variable degree of secondary annular dilatation. More specifically, an operation at the valvular level other than simple annuloplasty and in the presence of normal valve leaflets was conceived to eliminate the consequences of the underlying left ventricular disease, and was thus provocatively termed "valve restoration."

Finally, although the authors report good short-term results, we advise caution in applying a similar concept to rheumatic mitral insufficiency, especially in younger patients. We feel that the mitral valve stiffness after a rheumatic inflammatory process prevents adequate mobilization to achieve satisfactory coaptation without performing adjunctive procedures. Furthermore, retraction often involves both leaflets and the subvalvular apparatus, and disease tends to progress with time determining a higher incidence of medium- to long-term relapsing valve regurgitation. On the contrary, outcome of surgically corrected ischemic mitral insufficiency is highly correlated with the coexisting regional or global left ventricular dysfunction [3], and longer-term results are thus strictly dependent on the progression of ventricular remodeling.

	References

Top References

 

1. Izumoto H, Kawazoe K. Technique of posterior mitral valve restoration (letter) Ann Thorac Surg 2006;81:786.[Free Full Text]
2. Fundarò P, Pocar M, Moneta A, Donatelli F, Grossi A. Posterior mitral valve restoration for ischemic regurgitation Ann Thorac Surg 2004;77:729-730.[Abstract/Free Full Text]
3. Fundarò P, Pocar M, Donatelli F, Grossi A. Chronic ischemic mitral regurgitationtypes and subtypes. J Thorac Cardiovasc Surg 2002;124:855-856.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Pocar Andrea Moneta Pino Fundarò Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pocar, M. Articles by Fundarò, P. Search for Related Content PubMed Articles by Pocar, M. Articles by Fundarò, P. Related Collections Valve disease Related Article