Mechanism of Incomplete Mitral Leaflet Coaptation—Interaction of Chordal Restraint and Changes in Mitral Leaflet Coaptation Geometry

2002 ◽  
Vol 124 (5) ◽  
pp. 596-608 ◽  
Author(s):  
Sten Lyager Nielsen ◽  
Hans Nygaard ◽  
Lars Mandrup ◽  
Arnold A. Fontaine ◽  
J. Michael Hasenkam ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Spatial Relations ◽  
Functional Mitral Regurgitation ◽  
Papillary Muscles ◽  
Mitral Leaflet ◽  
Force Components ◽  
Leaflet Coaptation

Clinically observed incomplete mitral leaflet coaptation was reproduced in vitro by altering the balance of the chordal tethering and chordal coapting force components. Mitral leaflet coaptation geometry was distorted by changes of the spatial relations between the papillary muscles and the mitral valve as well as hemodynamics. Mitral leaflet malalignment was accentuated by a redistribution of the chordal tethering and coapting force components. For the overall assessment of systolic mitral leaflet configuration in functional mitral regurgitation it is important to consider the interaction between chordal restraint and an altered mitral leaflet coaptation geometry.

Abstract 3387: The Effects of Restrictive Annuloplasty on Mitral Leaflet Coaptation and The Mechanism Regulating Functional Mitral Regurgitation: Simplified Echocardiographic Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yasuhiro Shudo ◽  
Kazuhiro Taniguchi ◽  
Koichi Toda ◽  
Hajime Matsue ◽  
Hiroki Hata ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Significant Negative Correlation ◽  
Functional Mitral Regurgitation ◽  
Anterior Leaflet ◽  
Mitral Leaflet ◽  
Diastolic Phase ◽  
Simplified Method ◽  
Leaflet Coaptation ◽  
Lateral Diameter

Objectives: The effects of restrictive annuloplasty on mitral leaflet coaptation in a clinical setting have not been fully elucidated. We developed a novel simplified method for assessing the actual degree of coaptation and investigated changes caused by its use. Based on our findings, we evaluated the direct effects of restrictive annuloplasty on mitral leaflet coaptation and the mechanism regulating mitral regurgitation. Methods and Results: We studied 23 patients (mean 60 years old) with functional mitral regurgitation (grade 3 to 4+) with congestive heart failure (LV ejection fraction 32±10%) due to idiopathic (n=8) or ischemic (n=15) who underwent mitral valve repair with restrictive annuloplasty and 20 normal control subjects. We measured the septal-lateral diameter, tenting height, tenting area, and coaptation length of the mitral valve in 4-chamber, 2-chamber, and long-axis views at mid-systole before and after surgery using transthoracic and transesophageal echocardiography procedures. Coaptation length was calculated with the following formula: Ad-Ac, where Ad equals the whole length of the anterior leaflet during the diastolic phase and Ac equals the length of the non-coaptation free portion of the anterior leaflet at mid-systole. Coaptation length index was defined as the ratio of coaptation length to septal-lateral diameter. Results: Tenting height and tenting area were significantly decreased, while coaptation length and coaptation length index were significantly increased (Table ). In multivariate analysis, coaptation length index showed a statistically significant negative correlation with degree of residual MR (r=0.77, p<0.0001) and was found to be the most reliable predictor of MR grade. Conclusion: Our novel simplified method provided quantitative and morphological descriptions of mitral leaflet coaptation, and can also provide important information for developing a surgical strategy for regulation of MR. Table

Development of a Pulsatile Simulator for In-Vitro Analysis of the Mitral Valve Under Controlled Morphometric Conditions

2009 ◽  
Author(s):  
Andrea Pavesi ◽  
Riccardo Vismara ◽  
Emiliano Votta ◽  
Gianfranco B. Fiore
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Papillary Muscles ◽  
High Prevalence ◽  
Balance Of Forces ◽  
Vitro Analysis ◽  
Annular Dilation ◽  
In Vitro Analysis

Mitral valve (MV) pathologies of high prevalence, such as ischemic and functional mitral regurgitation, are secondary to the alteration of left ventricle geometry. The latter can lead to abnormal hemodynamics and induce annular dilation and papillary muscles (PMs) dislocation, thus modifying the physiologic balance of forces within the MV [1].

Functional and Degenerative Mitral Regurgitation: One Ring Fits All?

2019 ◽  
Vol 68 (06) ◽  
pp. 470-477
Author(s):  
Konstantinos Sideris ◽  
Johannes Boehm ◽  
Bernhard Voss ◽  
Thomas Guenther ◽  
Ruediger S. Lange ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Cumulative Risk ◽  
Functional Mitral Regurgitation ◽  
Combined Procedures ◽  
Echocardiographic Assessment ◽  
Leaflet Coaptation ◽  
Mid Term Results

Abstract Background Three-dimensional saddle-shaped annuloplasty rings have been shown to create a larger surface of leaflet coaptation in mitral valve repair (MVR) for functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) which may increase repair durability. For the first time, this study reports mid-term results after MVR for DMR and FMR using a rigid three-dimensional ring (Profile 3D, Medtronic). Methods Between June 2009 and June 2012, 369 patients with DMR (n = 326) or FMR (n = 43) underwent MVR (mean age 62.3 ± 12.6 years). A total of 205 patients (55.6%) underwent isolated MVR and 164 patients (44.4%) a combined procedure. Follow-up examinations were performed in 94.9% (mean 4.9 ± 0.9 years). Echocardiographic assessment was complete in 93.2% (mean 4.3 ± 1.2 years). Results The 30-day mortality was 1.5% (5/326) for DMR (1.5% for isolated and 1.6% for combined procedures) and 9.3% (4/43) for FMR (0% for isolated and 10.5% for combined procedures). Survival at 6 years was 92.1 ± 1.9% for DMR (92.9 ± 2.6% for isolated and 90.7 ± 2.7% for combined procedures) and 66.4 ± 7.9% for FMR (80.0 ± 17.9% for isolated and 63.7 ± 8.9% for combined procedures). Cumulative risk for mitral valve-related reoperation at 6 years was 0% for FMR and 7.1 ± 1.5% for DMR. At echocardiographic follow-up, one patient presented with mitral regurgitation (MR) more than moderate. The only predictor of recurrent MR after MVR for DMR was residual mild MR at discharge. Conclusion Repair of FMR with the three-dimensional Profile 3D annuloplasty ring shows excellent mid-term results with regard to recurrence of MR. In cases of DMR, the results are conforming to the current literature.

scholarly journals Influence of Chronic Tethering of the Mitral Valve on Mitral Leaflet Size and Coaptation in Functional Mitral Regurgitation

2012 ◽  
Vol 5 (4) ◽  
pp. 337-345 ◽  
Author(s):  
Ken Saito ◽  
Hiroyuki Okura ◽  
Nozomi Watanabe ◽  
Kikuko Obase ◽  
Tomoko Tamada ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet

Papillary Muscle Heads Focalization for Functional Mitral Regurgitation with Severe Tethering

2021 ◽  
Author(s):  
Masatoshi Hata ◽  
Sabine Bleiziffer ◽  
René Schramm ◽  
Jan F. Gummert
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Functional Mitral Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Papillary Muscles ◽  
Posterior Leaflet ◽  
Mitral Leaflet

AbstractWe performed “Papillary muscle heads focalization” for three patients with severe functional mitral regurgitation with severe leaflet tethering (coaptation distance ≥1 cm and/or posterior leaflet angle ≥45 degrees). All separated papillary muscle heads were sutured together and both the anterolateral and posteromedial papillary muscles were reconstructed as single head papillary muscles. The stitches are positioned to adjust the levels of mitral leaflet tips, concerning the length of the marginal chordae connected to each head. A downsized annuloplasty is performed concomitantly. At discharge, no patient showed moderate/severe mitral regurgitation. Their coaptation lengths were 7.1, 8.5, and 8.3 mm.

scholarly journals Prognostic value of mitral valve tenting area in patients with functional mitral regurgitation

2019 ◽  
Vol 30 (3) ◽  
pp. 431-438
Author(s):  
Maria von Stumm ◽  
Florian Dudde ◽  
Simone Gasser ◽  
Tatiana Sequeira-Gross ◽  
Jonas Pausch ◽  
...  
Keyword(s):  
Survival Rate ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Primary Study ◽  
Mitral Leaflet ◽  
Cardiac Events ◽  
End Point ◽  
Increased Risk ◽  
Adverse Cardiac Events

Abstract OBJECTIVES Mitral valve (MV) repair in functional mitral regurgitation is still associated with suboptimal outcomes. Our goal was to determine whether the clinical outcome following MV repair correlates with preoperative tenting parameters. METHODS We retrospectively identified consecutive patients with functional mitral regurgitation who underwent an isolated MV annuloplasty during a 7-year period (2010–2016) from our institutional database. Preoperative tenting parameters (i.e. tenting height, coaptation length, tenting area, posterior mitral leaflet and anterior mitral leaflet angles and interpapillary muscle distance) were systematically measured. The primary end point was the composite of survival and freedom from adverse cardiac events. The follow-up protocol consisted of a structured clinical questionnaire and an analysis of the echocardiographic data. RESULTS A total of 240 patients (mean age 67.8 ± 9.8 years, 57% of men) were analysed. The overall 5-year survival rate for the whole study cohort was 74.7 ± 4.2%, and freedom from adverse cardiac events was 84.8 ± 3.4%. A tenting area ≥2.4 cm2 was identified as a cut-off value, independently predicting the composite primary study end point (hazard ratio 2.0; P = 0.03). Furthermore, a Kaplan–Meier analysis revealed a strong tendency towards worse 5-year outcomes in patients with a tenting area ≥2.4 cm2 (n = 153) versus patients with a tenting area &lt;2.4 cm2 (n = 87) (65.3 ± 5.5% vs 77.1 ± 6.3%; P = 0.06). CONCLUSIONS MV annuloplasty is associated with acceptable clinical and echocardiographic outcomes in patients with functional mitral regurgitation 5 years postoperatively. A preoperative tenting area ≥2.4 cm2 showed a strong trend towards a worse 5-year survival rate and an increased risk of adverse cardiac events after an isolated MV annuloplasty.

scholarly journals Mitral valve cleft gapping mechanism in functional mitral regurgitation: An in-vitro study

2021 ◽  
Vol 10 ◽  
pp. 100061
Author(s):  
Bo Gao ◽  
Zhongxi Zhou ◽  
Teng Jing ◽  
Stephanie Wang ◽  
Shamini Parameswaran ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
In Vitro Study ◽  
Vitro Study ◽  
Functional Mitral Regurgitation

Investigation of the Fatigue Properties of Mitral Valve Leaflets

2013 ◽  
Author(s):  
Nastaran Shahmansouri ◽  
Farhad Javid ◽  
Damiano Pasini ◽  
Jorge Angeles ◽  
Marco Amabili ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Ventricular Dysfunction ◽  
Cyclic Fatigue ◽  
Fatigue Properties ◽  
Functional Mitral Regurgitation ◽  
Tissue Stiffness

Annulus dilation is one of the main causes of functional mitral regurgitation. Although the annulus dilation is usually accompanied by left ventricle dilation and dysfunction, the mechanical relation between them is not fully elucidated yet. In this paper, the assumption is made that the ventricular dysfunction increases the cyclic loading conditions on the mitral valve apparatus. This effect may cause fatigue and weaken the tissue. This hypothesis is investigated in vitro by applying increased cyclic loadings to the tissue and evaluating the tissue stiffness during the cycles. The results of this study show that the tissue loses its strength after cyclic fatigue loadings.

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