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• W4255548877 abstract "We appreciate the interest of Drs Izumoto and Kawazoe [1Izumoto H. Kawazoe K. Technique of posterior mitral valve restoration (letter).Ann Thorac Surg. 2006; 81: 786Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] in our “posterior mitral valve restoration” technique to treat mitral insufficiency after inferior myocardial infarction [2Fundarò P. Pocar M. Moneta A. Donatelli F. Grossi A. Posterior mitral valve restoration for ischemic regurgitation.Ann Thorac Surg. 2004; 77: 729-730Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar]. 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 [3Fundarò P. Pocar M. Donatelli F. Grossi A. Chronic ischemic mitral regurgitation types and subtypes.J Thorac Cardiovasc Surg. 2002; 124: 855-856PubMed Scopus (3) Google Scholar], and longer-term results are thus strictly dependent on the progression of ventricular remodeling. Technique of Posterior Mitral Valve RestorationThe Annals of Thoracic SurgeryVol. 81Issue 2PreviewWe read with interest the report by Fundarò and associates [1] concerning an original technique of mitral valve repair. They are to be commended for bringing up an “original” technique and successfully treating patients with ischemic mitral regurgitation using the new technique. Full-Text PDF" @default.
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• W4255548877 date "2006-02-01" @default.
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• W4255548877 title "Reply" @default.
• W4255548877 doi "https://doi.org/10.1016/j.athoracsur.2005.05.018" @default.
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