Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function.We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups.The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups’ baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group.This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.Key words: Cardiac output, chordae tendineae/surgery, left ventricular function, mitral valve replacement, mitral valve stenosis/surgery, papillary muscles/surgery, subvalvular apparatus, tissue preservation/methods, ventricular function, leftMitral valve replacement (MVR) with a mechanical or a bioprosthetic valve is one of the most performed cardiac surgical procedures. Although in recent years valve repair has usually been preferred to replacement, MVR is inevitable when repair is not feasible. After MVR, low cardiac output syndrome develops in some patients, because the subvalvular apparatus has not been spared.¹ Because the subvalvular apparatus provides continuity between the mitral annulus and the left ventricular (LV) wall through the leaflets, chordae tendineae, and papillary muscles, it plays an important role in LV function.² Several studies^3–3 have shown that protection of the subvalvular apparatus during MVR can decrease the risk of low cardiac output syndrome, reduce the operative mortality rate, and improve postoperative LV systolic function. Various approaches to subvalvular apparatus preservation have been developed.^6–9Papillary muscle repositioning (PMR) is a subvalvular apparatus-sparing method that can be applied to both the anterior and posterior mitral annulus. In patients with LV dysfunction and mitral regurgitation, several studies^10,11 have shown favorable effects of papillary muscle repositioning on LV remodeling; however, the effect of subvalvular-apparatus-sparing surgery (including PMR) on LV mechanics has not yet been fully elucidated in patients who have isolated mitral stenosis and preserved LV function.^12,13In this study, we examined the effectiveness of PMR on LV function and clinical outcome in patients with isolated mitral stenosis and preserved LV systolic function who undergo MVR.     

Prognostic value of pretreatment tumor-to-blood standardized uptake ratio (SUR) in rectal cancer

Annals of Nuclear Medicine - The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in...     

Unexpected injury of the orthopaedic surgeon: a case report of a hammer splinter

Sharps injuries have become one of the most important occupational injuries and they are common during surgery, with rates between 1.7 and 6.9% of all surgical procedures. This case report, however, revealed an extremely rare and unexpected condition, which could not be prevented by the reasonable safety precautions against injury. Closed reduction and closed intramedullary fixation was planned for the patient with humeral shaft fracture. While advancing the nail by hammering a piece of metal detached. A short time following the commencement of the procedure, the surgeon who was performing the operation felt a sudden severe pain in the neck. A radio-opaque intensity in the cervical region was detected on X-rays. There was a piece of metal from the hammer. The risk encountered in the present case comprises a condition, the prevention of which is probably impossible with the frequently utilized preventive measures against injuries. For this reason, the operating room team and in particular, the surgeon, should be careful about possible expected injuries, as well as the unexpected ones. Sharps injuries continue to be a serious concern for all healthcare workers. In some studies however, reporting of sharps injuries by healthcare workers remains a problem with reporting levels cited as low as 15% and as high as 90% (Kerr H-L, Stewart N Ann R Coll Surg Engl 91:430–432, [6]). Guo et al. pointed out the most recent sharps injuries at work, and syringe needles was by far the most important items causing injuries, followed by glass products, suture needles, and intravenous catheters.     

The effect of leukocyte-platelet-rich fibrin on bone morphogenetic protein-2 and insulin-like growth factor-1 levels in patients with chronic periodontitis: a randomized split mouth clinical trail

The present study evaluates the effects of leukocyte-platelet-rich fibrin (L-PRF) combined with open flap debridement (OFD) on clinical parameters and growth factors levels (GFL) in chronic periodontitis (CP) patients. This trial was registered at clinicaltrials.gov as NCT02594605. 16 patients (32 sites) with chronic periodontitis who had at least two areas of horizontal bone loss, were treated with OFD alone or L-PRF with OFD (OFD?+?L-PRF). GFL in gingival crevicular fluid (GCF) were analyzed at baseline, 1?week, 2?weeks and 4?weeks after operation. Probing depth (PD) and clinical attachment level (CAL) were measured at baseline and 6?months postoperatively. PD reduction and CAL gain were significantly higher in the OFD?+?L-PRF sites than in OFD sites. OFD?+?L-PRF group showed significantly increased bone morphogenetic protein-2 and insulin-like growth factor-1 at 2?weeks compared with baseline. L-PRF combined with OFD significantly increases GFL and thus, it enhances the periodontal healing on CP patients.