Document Detail


Posterior leaflet augmentation improves leaflet tethering in repair of ischemic mitral regurgitation.
MedLine Citation:
PMID:  21546260     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Ischemic mitral regurgitation results from annular dilatation, leaflet tethering and leaflet flattening. Undersized annuloplasty corrects annular dilatation but worsens leaflet tethering and flattening. This exacerbation of abnormal leaflet geometry may contribute to poor repair results for ischemic mitral regurgitation (IMR). Using a sheep model of IMR, we hypothesized that posterior leaflet augmentation and less-extreme annular undersizing would relieve tethering and increase leaflet curvature.
METHODS: Eight weeks after posterolateral infarct, 10 sheep with ≥ 2+ IMR underwent either a 24-mm planar ring annuloplasty (n = 5) or a 30-mm planar ring annuloplasty with concomitant posterior leaflet augmentation (n = 5). Real-time three-dimensional echocardiography allowed measurement of indices of leaflet curvature and tethering before and after annuloplasty.
RESULTS: Comparing pre- and post-repair values in the P1, P2, and P3 leaflet regions, undersized 24-mm ring annuloplasty made no significant difference to mean septolateral curvature (0.23-0.26, 0.33-0.29, and 0.27-0.37 cm(-1), respectively), whereas leaflet augmentation in combination with a 30-mm ring annuloplasty increased septolateral curvature (P1 0.30-1.02, P2 0.31-1.23, and P3 0.35-0.84 cm(-1), p-values<0.05). The mean tethering angle formed between the annular plane and the posterior leaflet increased in all three posterior regions for the 24-mm ring group (P1 12-23°, P2 26-31°, and P3 16-25°), but decreased in all regions for the group undergoing leaflet augmentation (P1 +5 to -6°, P2 +13 to -13°, P3 +16-15°, all p-values < 0.05).
CONCLUSIONS: Undersized annuloplasty exacerbates leaflet tethering. Posterior leaflet augmentation with less severe annular reduction increases leaflet curvature and decreases tethering; this technique more completely addresses the pathogenic mechanism of IMR and may improve repair durability.
Authors:
J Daniel Robb; Masahito Minakawa; Kevin J Koomalsingh; Takashi Shuto; Arminder S Jassar; Sarah J Ratcliffe; Robert C Gorman; Joseph H Gorman
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-05-04
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  40     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-15     Completed Date:  2012-03-06     Revised Date:  2013-09-09    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1501-7; discussion 1507     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA PA 19036, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Disease Models, Animal
Echocardiography, Three-Dimensional / methods
Hemodynamics / physiology
Male
Mitral Valve / surgery*
Mitral Valve Annuloplasty / methods*
Mitral Valve Insufficiency / etiology,  pathology,  surgery*,  ultrasonography
Myocardial Infarction / complications,  pathology
Pericardium / transplantation
Sheep
Grant Support
ID/Acronym/Agency:
HL63954/HL/NHLBI NIH HHS; HL73021/HL/NHLBI NIH HHS; R01 HL063954/HL/NHLBI NIH HHS; R01 HL103723/HL/NHLBI NIH HHS
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