Document Detail


Persistence of mitral regurgitation following ring annuloplasty: is the papillary muscle outside or inside the ring?
MedLine Citation:
PMID:  22645858     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Ischemic mitral regurgitation (IMR) often persists, despite annular ring reduction. It has been hypothesized that persistent IMR following ring annuloplasty was related to a continued tethering of the mitral leaflets, as defined by the distance by which the papillary muscles (PMs) were displaced outside the mitral annular ring.
METHODS: Seven sheep (four acute, three chronic) with persistent mitral regurgitation (MR) following ring annuloplasty for IMR were studied using three-dimensional (3D) echocardiography to examine the mitral valve geometry. The three stages examined were: Stage 1, baseline; Stage 2, post myocardial infarction (via ligation of the obtuse marginal branches); and Stage 3, post undersized ring annuloplasty. The 3D echocardiography measurements included mitral annular area, tethering distance from the ischemic PM to the anterior annulus, and the outside displacement of the PM relative to ring PM displacement.
RESULTS: Persistent moderate MR remained in these seven sheep following undersized ring annuloplasty (MR vena contracta change (pre versus post ring): 7.0 versus 5.8 +/- 2.4 mm, p = NS), despite a reduction in the mitral annular area of 50 +/- 18% (10.3 +/- 6.3 versus 4.7 +/- 1.3 cm2). Ring annuloplasty shifted the posterior annulus towards the anterior annulus, such that the infarcted PM became displaced outside the mitral annulus. The projected displacement distance of the PM outside versus inside the annular ring was 8.4 +/- 2.4 mm outside mitral annulus post ring versus 3.6 +/- 2.5 mm within mitral annulus pre ring, p < 0001). The displacement distance from the infarcted PM to the mitral annulus restricted the ability of the posterior leaflet to move anteriorly, preventing effective coaptation. By multivariate analysis, this displacement distance was an important determinant of residual MR (p < 0.02).
CONCLUSION: Persistent MR following ring annuloplasty for IMR relates to persistently abnormal leaflet tethering, with restricted posterior leaflet motion due to PM displacement outside of the mitral annulus.
Authors:
Judy Hung; Jorge Solis; Mark D Handschumacher; J Luis Guerrero; Robert A Levine
Related Documents :
9630108 - Single-lead vdd pacing: long-term experience with four different systems.
20561108 - High-rate pacing reduces variability of repolarization and prevents repolarization-depe...
12695458 - Effects of l-arginine on flow mediated dilatation induced by atrial pacing in diseased ...
19570808 - Preserved cardiac synchrony and function with single-site left ventricular epicardial p...
11602548 - Washout collaterometry: a new method of assessing collaterals using angiographic contra...
23576288 - Subepicardial dysfunction leads to global left ventricular systolic impairment in patie...
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  21     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-05-31     Completed Date:  2012-06-28     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  218-24     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Animals
Mitral Valve Annuloplasty*
Mitral Valve Insufficiency / etiology*,  physiopathology
Papillary Muscles / physiopathology
Postoperative Complications / etiology*,  physiopathology
Sheep
Grant Support
ID/Acronym/Agency:
K24 HL067434/HL/NHLBI NIH HHS; K24 HL67434/HL/NHLBI NIH HHS; R01 HL038176/HL/NHLBI NIH HHS; R01 HL072265/HL/NHLBI NIH HHS; R01 HL092101/HL/NHLBI NIH HHS; R01 HL092101/HL/NHLBI NIH HHS; R01 HL092101-01A1/HL/NHLBI NIH HHS; R01 HL109506/HL/NHLBI NIH HHS; R01038176//PHS HHS; R21 EB005294/EB/NIBIB NIH HHS
Comments/Corrections

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


Previous Document:  Percutaneous closure of mitral paravalvular leaks: a systematic review and meta-analysis.
Next Document:  The effects of dynamic saddle annulus and leaflet length on transmitral flow pattern and leaflet str...