Impact of papillary muscle approximation on mitral valve configuration in the surgical correction of ischemic mitral regurgitation. 
Efficacy of papillary muscle approximation (PMA) has not been well defined.  Mitral valve configuration was assessed using echocardiography before and 1 week after the surgery in 27 consecutive patients undergoing surgical correction of ischemic MR.  Comparisons were made between patients undergoing restrictive mitral annuloplasty (RMAP) alone (n = 13, RMAP group) and those undergoing PMA in addition to RMAP (n = 14, PMA group).  In the RMAP group, the annular diameter was reduced by 43% after surgery, and annular reduction was greater in the posterior portion than in the anterior.  Consequently, the tethering angle of the posterior leaflet (PL) increased after surgery.  In the PMA group, the annular diameter was reduced by 33%, and annular reduction was greater in the posterior.  In this group also, the tethering angle of PL increased significantly after surgery, although the degree of augmentation was lower compared with that in the RMAP group.  The addition of PMA to RMAP could attenuate but do not eliminate the tethering augmentation of PL.