1. Papillary muscle repair surgery in ischemic mitral valve patients
Roland Fasol, MD, Fitzum Lakew, MD, Bettina Pfannmüller, MD, Marvin J Slepian, MD, Elrina Joubert-Hubner 
The Annals of Thoracic Surgery 
Volume 70, Issue 3, Pages (September 2000)
DOI: /S (00)

2. Fig 1
(A) The physiological anatomy of a papillary muscle, the chordae, and parts of the mitral valve leaflets. (B) The pathology of a degenerated and fibrotic elongated papillary muscle (arrow), as found in all patients of this study, resulting in a prolapse of one or more parts of mitral valve leaflets, but leafing the chordae intact. (C) The technique of papillary muscle shortening plasty using a pericardium pledged-reinforced PTFE suture. The PTFE suture is placed through the base of the papillary muscle on the one side, and through the elongated tip on the other side, in order to shorten the elongated part of the papillary muscle. (D) The outcome of the papillary muscle-shortening plasty, resulting in a correction of the leaflet prolapse.
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

3. Fig 2
(A) Intraoperative view of an ischemic mitral valve, when ischemia/infarction has resulted in elongation of papillary muscles leading to subsequent leaflet prolapse, causing mitral regurgitation. Clearly shown here is the prolapse (arrow) of the anterior leaflet (A2), compared to the middle scallop of the posterior leaflet (P2). (B) Close-up view of the papillary muscle showing a fibrotic elongated body (arrow). (C and D) A pericardium pledged-reinforced PTFE suture is placed through the base of the papillary muscle on the one side (arrow), and through the elongated tip on the other side (arrow), in order to shorten the elongated body of the papillary muscle. (E) Close-up view of the result of the papillary muscle-shortening plasty, showing the reconstructed papillary muscle. Arrows point at the pericardium pledged-reinforced PTFE suture. (F) Final result of the repair procedure: after the papillary muscle-shortening plasty and implantation of a Carpentier-Edwards “Physio” annuloplasty ring, the mitral valve is competent.
The Annals of Thoracic Surgery  , DOI: ( /S (00) )