Document Detail

Infarct restraint attenuates remodeling and reduces chronic ischemic mitral regurgitation after postero-lateral infarction.
MedLine Citation:
PMID:  12173827     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic ischemic mitral regurgitation (IMR) is produced by adverse postinfarction ventricular remodeling. We hypothesize that restraining infarct expansion reduces left-ventricular (LV) dilatation and the severity of mitral regurgitation.
METHODS: Two groups of 6 sheep had coronary snares placed around the second and third obtuse marginal coronary arteries and four piezoelectric transducers sutured within myocardium across the mid short axis of the LV. In one group, a patch of Marlex mesh was precisely fitted and lightly sutured to myocardium destined for infarction (determined by temporary snare occlusion). Two weeks after instrumentation, coronary snares were tied tight to infarct approximately 24% of the posterolateral LV mass. Transdiaphragmatic echocardiograms were obtained in all animals at baseline, and 30 minutes, and 2, 5, and 8 weeks after infarction.
RESULTS: Echocardiograms confirmed similar infarct sizes and locations in both groups. Eight weeks after infarction, IMR grade averaged 3.6+ (scale: 0, no MR; 4, severe MR) in control sheep and 1.9+ in mesh-restrained animals (p = 0.0001). LV end-diastolic and end-systolic volumes at the eighth week were less in mesh-treated sheep (87 +/- 11.3 vs 113 +/- 18.3; 61 +/- 10.6 vs 77 +/- 14.1, respectively), but differences were not significant. Data from mid short axis piezoelectric transducers indicated significantly less strain in the infarcted myocardium in mesh-restrained sheep than in control.
CONCLUSIONS: Early restraint of postero-lateral infarct expansion attenuates the severity of ischemic mitral regurgitation and slows ventricular dilatation. However, the remodeling process is not arrested 8 weeks after infarction.
Sina L Moainie; T Sloane Guy; Joseph H Gorman; Theodore Plappert; Benjamin M Jackson; Martin G St John-Sutton; L Henry Edmunds; Robert C Gorman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-08-13     Completed Date:  2002-09-27     Revised Date:  2013-09-09    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  444-9; discussion 449     Citation Subset:  AIM; IM    
Harrison Department of Surgical Research, University of Pennsylvania School of Medicine, Philadelphia, USA.
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MeSH Terms
Chronic Disease
Mitral Valve Insufficiency / etiology,  prevention & control*
Myocardial Infarction / complications,  therapy*
Myocardial Ischemia / etiology,  prevention & control
Ventricular Remodeling*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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