Septal-lateral annular cinching abolishes acute ischemic mitral regurgitation

Tomasz A. Timek, David T. Lai, Frederick Tibayan, David Liang, George T. Daughters, Paul Dagum, Neil B. Ingels, D. Craig Miller

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


Objective: Ring annuloplasty prevents acute ischemic mitral regurgitation in sheep, but it also abolishes normal mitral annular and posterior leaflet dynamics. We investigated a novel surgical approach of simple septal-lateral annular cinching with sutures to treat acute ischemic mitral regurgitation. Methods: Nine adult sheep underwent implantation of multiple radiopaque markers on the left ventricle, mitral anulus, and mitral leaflets. A septal-lateral transannular suture was anchored to the midseptal mitral anulus and externalized to a tourniquet through the midlateral mitral anulus and left ventricular wall. Open-chest animals were studied immediately postoperatively. Acute ischemic mitral regurgitation was induced by means of proximal left circumflex artery snare occlusion, and 3 progressive steps of septal-lateral annular cinching (each 2-3 mm suture tightening for 5 seconds) were performed with the transannular suture. Biplane videofluoroscopy for 3-dimensional marker coordinates and transesophageal echocardiography were performed continuously before and during left circumflex ischemia and septallateral annular cinching. Results: Acute left circumflex ischemia caused ischemic mitral regurgitation (+0.5 ± 0.4 [baseline] vs +2.0 ± 0.7 [ischemia]; P = .005; scale, +0-4), which decreased progressively with each step of septal-lateral annular cinching and was eliminated during the third step (ischemic mitral regurgitation, +0.6 ± 0.5; P = not significant vs baseline). The third step of septal-lateral annular cinching decreased the septal-lateral diameter by 6.0 ± 2.6 mm (P = .005); however, mitral anulus area reduction (8.5% ± 1.0% and 6.9% ± 1.9% for ischemic mitral regurgitation and septal-lateral annular cinching step 3, respectively; P = .006) and posterior leaflet excursion (50° ± 9° and 44° ± 11° for regurgitation and annular cinching step 3, respectively; P = .002) throughout the cardiac cycle were affected only mildly. Normal mitral annular 3-dimensional shape was maintained with septal-lateral annular cinching. Conclusions: Isolated 22% ± 10% reduction in mitral annular septal-lateral dimension abolished acute ischemic mitral regurgitation in normal sheep hearts while allowing near-normal mitral annular and posterior leaflet dynamic motion. Septallateral annular cinching may represent a simple method for the surgical treatment of ischemic mitral regurgitation, either as an adjunctive technique or alone, which helps preserve physiologic annular and leaflet function.

Original languageEnglish (US)
Pages (from-to)881-888
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number5
StatePublished - May 1 2002
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Septal-lateral annular cinching abolishes acute ischemic mitral regurgitation'. Together they form a unique fingerprint.

Cite this