ISCHEMIC MITRAL REGURGITATION REPAIR: A NOVEL TECHNIQUE

Dr Intekhab Alam; Dr Jyoti Prasad Kalita; Prof. Manuj Kumar Saikia

Volume : VII, Issue : IV, April - 2018

ISCHEMIC MITRAL REGURGITATION REPAIR: A NOVEL TECHNIQUE

Dr Intekhab Alam, Dr Jyoti Prasad Kalita, Prof. Manuj Kumar Saikia

Abstract :

A 53–year–old man who presented with chest pain and sudden onset dyspnea on exertion to emergency department. He was in NYHA Class IV and was shifted immediately to cardiac intensive care unit. Coronary angiogram was done was suggestive of blockage of proximal circumflex with normal left anterior descending artery&right coronary artery. Patient was intubated & decongestive measures were started. Pre–op trans–thoracic echocardiography could only reveal RWMA (regional wall motion abnormality) of infero–basal wall with severe MR. He was then referred for urgent surgery of coronary artery bypass grafting with mitral valve replacement. During Intra–op transesophageal echocardiography, it was evident that there was rupture of anterolateral papillary muscle, leading to severe MR. After taking patient on cardio–pulmonary bypass and after diastolic arrest of heart, on opening findings of transesophageal echocardiography were confirmed. On assessing the anatomy, repair was done, by direct pledgeted suture re–implantation of anterolateral papillary muscle to LV base. Repair was reinforced with 30mm Carpentier– Edwards ring annuloplasty. CABG was done in which reverse saphenous vein grafted onto obtuse marginal anch of circumflex. Post–op was uneventful. Review ECHO was done 1 week after the discharge which was suggestive of mild LV dysfunction, infero–posterior wall hypokinesia, trivial MR and was found to be in NYHA Class II.