Mitral valve repair with papillary muscle sling for functional mitral regurgitation: application of double mitral ring concept in a case of ischemic cardiomyopathy and a case of idiopathic dilated cardiomyopathy

Functional mitral regurgitation (FMR) is a common complication in patients with ischemic heart disease or idiopathic dilated cardiomyopathy (DCM). We report successful application of a papillary muscle sling (PMS) to maintain the efficacy of undersized mitral annuloplasty (MAP) in two patients with FMR. A 5-mm expanded polytetrafluoroethylene tube was placed around the trabecular base of the papillary muscles and then tightened to make a sling that banded the two papillary muscles together. In case 1, a 57-year-old woman who had experienced anterolateral myocardial infarction underwent mitral valve reconstruction with undersized MAP and PMS in addititon to coronary revascularization for chronic ischemic mitral regurgitation. In case 2, we applied the same mitral valve procedure in a 65-year-old woman with idiopathic DCM. Neither had mitral insufficiency at an intermediate follow-up.