| The influence of saddle-shaped annuloplasty on leaflet curvature in patients with ischaemic mitral regurgitation. | |
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MedLine Citation:
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PMID: 22351705 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2012-02-20 |
Journal Detail:
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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:
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Created Date: 2012-08-13 Completed Date: 2013-01-17 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 493-9 Citation Subset: IM |
Affiliation:
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Glenolden Research Laboratory, Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Cohort Studies Echocardiography, Three-Dimensional / methods* Female Follow-Up Studies Heart Valve Prosthesis* Heart Valve Prosthesis Implantation / adverse effects, methods Humans Male 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 | |
ID/Acronym/Agency:
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HL63954/HL/NHLBI NIH HHS; HL70321/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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