Background: The key mechanism of functional mitral regurgitation(FMR) in cardiomyopathy is leaflet tethering caused by displacement of the papillary muscles(PM) due to left ventricular dilatation. The attendant remodeling process is characterized by intraventricular widening between both PM. Recently, surgical ventricular restoration (SVR) has been proposed as a technique to reduce leaflet tethering by improving ventricular geometry. However, it is unknown how SVR improve FMR. Methods and Results: From 2003 to 2010,we surgically treated FMR in 100 patients with idiopathic dilated cardiomyopahy (DCM) or ischemic cardiomyopathy (ICM).Of those, we performed posterior wall exclusion proceduresby either resection (the Batista procedure, n=13) or plication (n=19) to approximate papillary muscle distance in a total of 32 patients (DCM in 17, ICM in 15), and these patients formed the cohort of this study. There were two 30-day mortalities (6.3%). There was no significant change in left ventricular ejection fraction, however, the size of the left ventricle, degree of MR, tethering height and distance of PM significantly decreased after operation and well maintained at the mean follow up of 3.3 ±2.1 years. Conclusions: Posterior wall resection or plication with PMapproximation provides excellent reduction of leaflet tethering and MR. Thus, reduction of PM distance may be helpful to treat FMR due to leaflet tethering.
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