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Papillary muscle sling and overlapping cardiac volume reduction with aortic valve replacement for valvular cardiomyopathy

Department of Cardiovascular Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Naka, Hamamatsu, Shizuoka 432-8580, Japan

*Corresponding author. Tel.: +81-53-453-7111; fax: +81-53-452-9217.

E-mail address: k-yama{at}hmedc.or.jp (K. Yamamoto).

A 63-year-old male was admitted to our hospital because of severe aortic regurgitation. The left ventricle was extremely dilated and mild functional mitral regurgitation was detected because of outward displacement of papillary muscles. We used a papillary muscle sling with aortic valve replacement to correct the widened distance between the papillary muscles. A papillary muscle sling when used for reducing tethering at the mitral valve also reduces the posterior left ventricular volume. As well, a transmural longitudinal incision along the left anterior descending artery in the left ventricular free wall was sutured by an overlapping method to reduce the anterior left ventricular volume. The combination of papillary muscle sling and the overlapping method does not need any resection of the cardiac muscle and so would be beneficial for end-stage valvular cardiomyopathy.

Key Words: Papillary muscle sling; Overlapping cardiac volume reduction; Aortic regurgitation; Valvular cardiomyopathy