Document Detail

The influence of saddle-shaped annuloplasty on leaflet curvature in patients with ischaemic mitral regurgitation.
MedLine Citation:
PMID:  22351705     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Reports indicate that repair procedures for ischaemic mitral regurgitation (IMR) are less durable than previously thought. Repair failure has been shown to be stress related. Leaflet curvature is the major determinant of valve stress. Theoretical and animal experiments have shown that saddle-shaped annuloplasty optimizes leaflet curvature when compared with standard flat ring annuloplasty. Despite this, the influence of the ring shape on leaflet curvature has not been described in patients with IMR. This study uses real-time three-dimensional echocardiography (rt-3DE) to assess the influence of the ring shape on leaflet curvature.
METHODS: Rt-3DE was performed in 21 patients with IMR after placement of either a flat (n = 10, CE-Physio, Edwards) or saddle-shaped (n = 11, Profile 3D, Medtronic) annuloplasty ring. A combination of commercially available and customized software was used to measure multiple leaflet curvature parameters across all regions of the mitral valve.
RESULTS: Independently of the shape of the annuloplasty ring, all patients were subject to the same degree of annular undersizing. Patients who received saddle-shaped annuloplasty rings had greater leaflet curvature in all six mitral valve leaflet regions (A1 = 0.36 ± 0.10, A2 = 0.53 ± 0.13, A3 = 0.47 ± 0.13, P1 = 0.35 ± 0.23, P2 = 0.53 ± 0.34, P3 = 0.42 ± 0.20 cm(-2)) compared with patients who received flat annuloplasty rings (A1 = 0.16 ± 0.11, A2 = 0.18 ± 0.09, A3 = 0.16 ± 0.11, P1 = 0.20 ± 0.17, P2 = 0.21 ± 0.11, P3 = 0.18 ± 0.13 cm(-2)). These differences were statistically significant in all regions except the P1 region.
CONCLUSIONS: Saddle-shaped annuloplasty rings increase leaflet curvature compared with flat rings in patients with IMR. As a result, saddle-shaped annuloplasty may decrease leaflet stress and potentially increases the durability of the repair in patients with IMR.
Mathieu Vergnat; Melissa M Levack; Arminder S Jassar; Benjamin M Jackson; Michael A Acker; Y Joseph Woo; Robert C Gorman; Joseph H Gorman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-02-20
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  42     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-13     Completed Date:  2013-01-17     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:  493-9     Citation Subset:  IM    
Glenolden Research Laboratory, Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.
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MeSH Terms
Age Factors
Cohort Studies
Echocardiography, Three-Dimensional / methods*
Follow-Up Studies
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  methods
Middle Aged
Mitral Valve Annuloplasty / adverse effects,  methods*
Mitral Valve Insufficiency / complications,  surgery*,  ultrasonography*
Myocardial Ischemia / complications,  surgery*
Postoperative Complications / physiopathology,  ultrasonography
Prosthesis Design
Prosthesis Failure
Risk Assessment
Stress, Mechanical
Time Factors
Treatment Outcome
Grant Support

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

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