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Objective: There are many surgical approaches in the treatment of functional mitral regurgitation. Since functional mitral regurgitation is a ventricular problem and not a valvular one, some authors have suggested concentrating our therapeutic efforts on the subvalvular apparatus with the use of papillary muscle slings. The limited data of this approach has been mainly in patients undergoing median sternotomy. Herein, we describe a case that was performed via a minimally invasive approach.
Methods: A 39 year female with a 2 year history of peripartum cardiomyopathy was in New York Heart Association Heart Failure Class III-IV. Echocardiogram performed showed a dilated cardiomyopathy with an ejection fraction of 20%, severe mitral regurgitation. She underwent minimally invasive mitral valve repair with placement of an annuloplasty ring along with placement of 4-mm polytetrafluoroethylene tube placed around the papillary muscles drawing them together, correcting their lateral and downward displacement.
Results: Postoperatively, no mitral regurgitation was noted immediately or 2 weeks later. There was a decrease on the tenting effect from 0.8 mm to 0.3 mm, the cavity diameters decreased. She had significant improvement of her symptoms, being in New York Heart Association Heart Failure Class I-II at the time of discharge.
Conclusions: Placement of a papillary muscle sling during mitral valve repair for functional mitral regurgitation via a miminally invasive approach is safe and feasible with immediate geometric and hemodynamic effect on the mitral valve. Durability and long term effects need to evaluated