Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Figure 4

(a–c) Different surgical techniques of handling subvalvular apparatus. (a, b) Anatomy of the papillary muscles and corresponding handling surgical technique. (a) Type I, single uniform unit; type II, groove with two apexes (blue arrow). PMA using Goretex 4-0 stitch. (b) Type III, fenestrations with muscular bridges; type IV, complete separation in two adjacent heads; type V, complete separation with two distant heads (purple arrow). PMA using Goretex 4-0 prosthetic for PM sling. (c) Papillary muscle relocation through the fixation of the PMs to the trigone: APM (green arrow) and PPM (red arrow).