scholarly journals Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model

2012 ◽  
Vol 144 (1) ◽  
pp. 235-242 ◽  
Author(s):  
Haruo Yamauchi ◽  
Nikolay V. Vasilyev ◽  
Gerald R. Marx ◽  
Hugo Loyola ◽  
Muralidhar Padala ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Porcine Model ◽  
Ex Vivo ◽  
Valve Repair ◽  
Novel Technique ◽  
Functional Tricuspid Regurgitation

scholarly journals Right ventricular papillary muscle approximation for functional tricuspid regurgitation associated with severe leaflet tethering†

2017 ◽  
Vol 26 (4) ◽  
pp. 700-702 ◽  
Author(s):  
Goro Matsumiya ◽  
Hiroki Kohno ◽  
Kaoru Matsuura ◽  
Tomoki Sakata ◽  
Yusaku Tamura ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Functional Tricuspid Regurgitation

scholarly journals Development of a gel dedicated to gel immersion endoscopy

2021 ◽  
Vol 09 (06) ◽  
pp. E918-E924
Author(s):  
Tomonori Yano ◽  
Atsushi Ohata ◽  
Yuji Hiraki ◽  
Makoto Tanaka ◽  
Satoshi Shinozaki ◽  
...  
Keyword(s):  
Electrical Conductivity ◽  
Porcine Model ◽  
Ex Vivo ◽  
In Vitro Experiments ◽  
Efficacy And Safety ◽  
Coagulative Necrosis ◽  
Novel Technique ◽  
In Vivo Experiments

Abstract Backgrounds and study aims Gel immersion endoscopy is a novel technique to secure the visual field during endoscopy. The aim of this study was to develop a dedicated gel for this technique. Methods To identify appropriate viscoelasticity and electrical conductivity, various gels were examined. Based on these results, the dedicated gel “OPF-203” was developed. Efficacy and safety of OPF-203 were evaluated in a porcine model. Results  In vitro experiments showed that a viscosity of 230 to 1900 mPa·s, loss tangent (tanδ) ≤ 0.6, and hardness of 240 to 540 N/cm2 were suitable. Ex vivo experiments showed electrical conductivity ≤ 220 μS/cm is appropriate. In vivo experiments using gastrointestinal bleeding showed that OPF-203 provided clear visualization compared to water. After electrocoagulation of gastric mucosa in OPF-203, severe coagulative necrosis was not observed in the muscularis but limited to the mucosa. Conclusions OPF-203 is useful for gel immersion endoscopy.

Abstract 16979: Hemodynamic Comparison of Tricuspid Ring Annuloplasty vs. Hetzer Annuloplasty Technique to Repair Functional Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alan Amedi ◽  
Daisuke Onohara ◽  
Muralidhar Padala
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Ex Vivo ◽  
Working Fluid ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Ex Vivo Model ◽  
Functional Tricuspid Regurgitation ◽  
Ring Annuloplasty ◽  
Valve Function

Introduction: Surgical repair of functional tricuspid regurgitation (FTR) is increasingly performed, and the techniques are evolving. Annuloplasty is currently the technique of choice, with different techniques yielding varied results, and thus require optimization. Objective: In this study, we sought to compare tricuspid valve function and kinematics after ring annuloplasty and Hetzer’s double orifice repair in an ex vivo model of FTR. Methods: Ten pig hearts were mounted into a right heart simulator, and studied at 70 bpm while maintaining the total volume of working fluid. FTR was created by increasing afterload, which caused acute right ventricular dilation and TV tethering. Tricuspid valve annuloplasty (TVA) was performed with a 26mm MC 3 ring. Hetzer procedure was performed with pledgeted sutures that approximated the anteroposterior and septal annular segments. Flow probes were used to measure FTR, and leaflet kinematics with echocardiography. Results: FTR of 17.7±9.2mL(p<0.0001) after RV dilation. Repair with TVA and Hetzer reduced FTR to 8.8±6.8ml(p=0.7142) and 7.8±6.9ml(p=0.0919), respectively, but did not eliminate it. Septal leaflet excursion angle decreased by 48.1% with FTR (p=0.04 vs. baseline ) . Repair with TVA and Hetzer increased the angle to 17.3±6.7°(p=0.0312) and 21.5±8.3°(vs FTR, p=0.0034), respectively. The Hetzer improved septal leaflet mobility better than TVA (p=0.0145). The posterior leaflet excursion angle decreased by 49.2% compared to baseline to 18.4±10.5° (p=0.0060) and both TVA and Hetzer significantly improved mobility to 33.6±8.4° (p=0.0081) and 31.6±15.6° (p=0.0256), respectively. Anterior leaflet mobility decreased after FTR by 60.7% to 18.1±8.2°. The effect of these repairs on the sub-valvular apparatus was negligible. Conclusion: TVA and Hetzer both reduced regurgitation but did not eliminate it. Septal and posterior leaflet mobility was improved, while the anterior leaflet remained tethered.

“The Balloon Plug Concept” for Tricuspid Valve Repair Ex Vivo Proof of Concept

2015 ◽  
Vol 10 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Pietro Bajona ◽  
Stefano Salizzoni ◽  
Stijn Vandenberghe ◽  
Charles J. Bruce ◽  
Giovanni Speziali ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Ex Vivo ◽  
Tricuspid Valve Repair ◽  
Functional Tricuspid Regurgitation ◽  
Novel Approach ◽  
Annular Dilatation ◽  
Transvalvular Gradient ◽  
Antegrade Flow ◽  
The Right

Objective Functional tricuspid regurgitation (TR) is recognized as a significant cause of morbidity and mortality in cardiothoracic surgery. We hypothesized that a variably expandable, transvalvular balloon mounted on a catheter could be percutaneously inserted and fixed to the right ventricle apex. This novel approach could provide a minimally invasive way to eliminate clinically relevant TR caused by annular dilatation. This study was performed to test the ex vivo hemodynamic effects and the feasibility of the “balloon plug concept.” Methods Twenty harvested calf tricuspid valves were placed in a mechanical simulator. Tricuspid regurgitation was created by annular stretching and displacement of the papillary muscles so as to create central TR. A flexible catheter with a 4-cm–long, soft, fusiform balloon was positioned across the valve so that the balloon was suspended centrally across the valve annular plane. After activating the mechanical ventricle, data were collected with balloon inflation volumes of saline from 5 to 20 mL. Transvalvular pressure gradients and leaflet mechanics were evaluated with incremental inflation. Results In all cases, 5-mL inflation did not significantly reduce TR and 20-mL inflation caused obstruction to antegrade flow (mean transvalvular gradient > 4 mm Hg). Inflation between 10 and 15 mL caused significant reduction in TR with acceptable transvalvular gradients (<3 mm Hg). Conclusions The balloon plug concept showed promising ex vivo hemodynamic results. In vivo investigations are warranted to evaluate percutaneous techniques, thrombogenicity, and effects of repeated balloon-leaflet contact on valve integrity.

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