In selected patients with a BA <145° and coaptation depth ≤10 mm, CC is related to less MR return or persistence, improved EF, and lower New York Heart Association class.

Although the rationale for the use of the U technique is different from what is generally accepted, the midterm results of this approach are comparable to those obtained with more conventional techniques, remaining stable after a mean follow-up of 18 months.

ObjectiveThe proper treatment of chronic ischemic mitral regurgitation (CIMR) is still under evaluation. The different role of mitral valve repair (MVr) or mitral valve prosthesis insertion (MVPI) is still not defined.MethodsFrom May 2009 to December 2011 167 patients with ejection fraction (EF) ≤ 40% had MV surgery for CIMR, MVr in 135 (80.8%) and MVPI in 32 (19.2%). Indication to MVPI was a MV coaptation depth > 10 mm. EF was lower (26 ± 7 vs 32 ± 6, p = 0.0000) in MVPI, whereas MR grade (3.6 ± 0.8 vs 2.7 ± 0.9, p = 0.0000), left ventricle dimensions (end diastolic, LVEDD, 62 ± 7 vs 57 ± 6 mm, p = 0.0001; end systolic, LVESD, 49 ± 8 vs 44 ± 8 mm, p = 0.0018), systolic pulmonary artery pressure (51 ± 22 vs 41 ± 16 mm Hg, p = 0.0037) and NYHA Class (3.6 ± 0.5 vs 2.8 ± 0.6, p = 0.0000) were higher.ResultsIn-hospital mortality was similar (3.1 vs 3.7%) as well as 3-year survival (86 ± 6 vs 88 ± 4) and survival in NYHA Class I/II (80 ± 5 vs 83 ± 4). One hundred thirty nine patients had an echocardiographic evaluation after a minimum of 4 months (13 ± 8). EF rose significantly in both groups (from 26 ± 7% to 30 ± 4%, p = 0.0122, and from 32 ± 6% to 35 ± 8%, p = 0.0018). LVESD reduced significantly in both groups (from 49 ± 8 to 43 ± 9 mm, p = 0.0109, and from 44 ± 8 to 41 ± 7 mm, p = 0.0033). MR grade was significantly lower in patients who had MVPI (0.1 ± 0.2 vs 0.3 ± 0.3, p = 0.0011).ConclusionsWith appropriate indications, MVPI is a safe procedure which provides similar results to MVr with lower MR return, even if addressed to patients with worse preoperative parameters.

A 72-year-old male was evaluated for high thresholds in an implantable cardioverter defibrillator (ICD) (Medtronic Sprint Quattro Secure Model #6947; Medtronic, Inc., Minneapolis, MN, USA) initially inserted in 2005. Coronary angiography revealed three vessel disease and an echocardiogram showed an ejection fraction of 35%, severe mitral regurgitation, and moderate tricuspid regurgitation. The pigtail of the ICD lead appeared to lie over the left anterior descending artery (LAD) (Fig. 1). At the time of surgery, the lead was noted to be outside the heart adjacent to the LAD (Fig. 2). It had migrated through the body of the anterior papillary muscle of the tricuspid valve and across the anterior wall of the right ventricle. The lead was dissected free and the distal 10 mm was transected. The defect was repaired with an 8-0 prolene suture (Fig. 3). The patient underwent coronary revascularization, mitral and tricuspid valve repair, and epicardial implantation of an atrio-biventricular pacing system. He tolerated the procedure well and had an uncomplicated postoperative course.