scholarly journals Collagen Fibrillogenesis in the Mitral Valve: It’s a Matter of Compliance

2021 ◽  
Vol 8 (8) ◽  
pp. 98
Author(s):  
Richard L. Goodwin ◽  
Arash Kheradvar ◽  
Russell A. Norris ◽  
Robert L. Price ◽  
Jay D. Potts
Keyword(s):  
Mitral Valve ◽  
Triple Helix ◽  
Collagen Fibers ◽  
Elastic Fibers ◽  
Structural Components ◽  
Valvular Interstitial Cells ◽  
Chordae Tendineae ◽  
Valve Function ◽  
Dynamic Structures ◽  
Opening And Closing

Collagen fibers are essential structural components of mitral valve leaflets, their tension apparatus (chordae tendineae), and the associated papillary muscles. Excess or lack of collagen fibers in the extracellular matrix (ECM) in any of these structures can adversely affect mitral valve function. The organization of collagen fibers provides a sophisticated framework that allows for unidirectional blood flow during the precise opening and closing of this vital heart valve. Although numerous ECM molecules are essential for the differentiation, growth, and homeostasis of the mitral valve (e.g., elastic fibers, glycoproteins, and glycans), collagen fibers are key to mitral valve integrity. Besides the inert structural components of the tissues, collagen fibers are dynamic structures that drive outside-to-inside cell signaling, which informs valvular interstitial cells (VICs) present within the tissue environment. Diversity of collagen family members and the closely related collagen-like triple helix-containing proteins found in the mitral valve, will be discussed in addition to how defects in these proteins may lead to valve disease.

scholarly journals Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system

2020 ◽  
Author(s):  
Lars Walczak ◽  
Lennart Tautz ◽  
Mathias Neugebauer ◽  
Joachim Georgii ◽  
Isaac Wamala ◽  
...  
Keyword(s):  
Decision Support ◽  
Mitral Valve ◽  
Decision Support System ◽  
Support System ◽  
Heuristic Method ◽  
Mitral Valve Surgery ◽  
Chordae Tendineae ◽  
Mitral Valves ◽  
Interactive Editing ◽  
Opening And Closing

Abstract Purpose Decision support systems for mitral valve disease are an important step toward personalized surgery planning. A simulation of the mitral valve apparatus is required for decision support. Building a model of the chordae tendineae is an essential component of a mitral valve simulation. Due to image quality and artifacts, the chordae tendineae cannot be reliably detected in medical imaging. Methods Using the position-based dynamics framework, we are able to realistically simulate the opening and closing of the mitral valve. Here, we present a heuristic method for building an initial chordae model needed for a successful simulation. In addition to the heuristic, we present an interactive editor to refine the chordae model and to further improve pathology reproduction as well as geometric approximation of the closed valve. Results For evaluation, five mitral valves were reconstructed based on image sequences of patients scheduled for mitral valve surgery. We evaluated the approximation of the closed valves using either just the heuristic chordae model or a manually refined model. Using the manually refined models, prolapse was correctly reproduced in four of the five cases compared to two of the five cases when using the heuristic. In addition, using the editor improved the approximation in four cases. Conclusions Our approach is suitable to create realistically parameterized mitral valve apparatus reconstructions for the simulation of normally and abnormally closing valves in a decision support system.

A Complex Mitral Valve Reconstruction: A Case Report

2005 ◽  
Vol 6 (2) ◽  
pp. 27
Author(s):  
Dimitrios Buklas ◽  
Massimo Massetti ◽  
Eric Saloux ◽  
Eugenio Neri ◽  
Olivier LePage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Techniques ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Mitral Valve Reconstruction ◽  
Mitral Repair ◽  
Valve Reconstruction ◽  
Valve Insufficiency ◽  
Valve Function ◽  
Valvular Function

Several techniques are currently in use for mitral valve reconstruction. We report a mitral repair case in which the use of a combination of different surgical techniques resulted in the necessary correction. A 47-year-old woman underwent surgical intervention to treat severe mitral valve insufficiency due to A1/A2/A3 and P2 prolapsed valve tissue. A combination of quadrangular resection, sliding leaflet, single chordal transposition, "flip-over" leaflet, and ring annuloplasty techniques were applied, and postsurgical correct valve function was documented by results of a left ventricular saline filling test and transesophageal echocardiography control. Complex mitral valve repairing techniques can be combined to reestablish valvular function.

scholarly journals Biomechanical-Structural Correlation of Chordae tendineae in Animal Models: A Pilot Study

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1678
Author(s):  
Justyn Gach ◽  
Izabela Janus ◽  
Agnieszka Mackiewicz ◽  
Tomasz Klekiel ◽  
Agnieszka Noszczyk-Nowak
Keyword(s):  
Mitral Valve ◽  
Complex Structure ◽  
Future Research ◽  
Uniaxial Tensile ◽  
Uniaxial Tensile Test ◽  
Histopathological Analysis ◽  
Papillary Muscles ◽  
Chordae Tendineae ◽  
Structural Correlation ◽  
Ring Valve

The mitral valve apparatus is a complex structure consisting of the mitral ring, valve leaflets, papillary muscles and chordae tendineae (CT). The latter are mainly responsible for the mechanical functions of the valve. Our study included investigations of the biomechanical and structural properties of CT collected from canine and porcine hearts, as there are no studies about these properties of canine CT. We performed a static uniaxial tensile test on CT samples and a histopathological analysis in order to examine their microstructure. The results were analyzed to clarify whether the changes in mechanical persistence of chordae tendineae are combined with the alterations in their structure. This study offers clinical insight for future research, allowing for an understanding of the process of chordae tendineae rupture that happens during degenerative mitral valve disease—the most common heart disease in dogs.

scholarly journals Use of a Sandwich Technique to Repair a Left Ventricular Rupture after Mitral Valve Replacement

2014 ◽  
Vol 41 (2) ◽  
pp. 195-197 ◽  
Author(s):  
Myles E. Lee ◽  
Mallika Tamboli ◽  
Anthony W. Lee
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Sandwich Technique ◽  
Ventricular Rupture ◽  
Left Ventricular Rupture ◽  
Valve Function ◽  
Normal Mitral Valve

One difficulty with external repair of left ventricular rupture after mitral valve replacement is collateral bleeding in friable myocardium adjacent to the rupture. The bleeding is caused by tension on the closing sutures, whether or not pledgets have been used. We report the case of a 69-year-old woman who underwent an uneventful mitral valve replacement. After cardiopulmonary bypass was terminated, brisk bleeding started from high in the posterior left ventricular wall, typical of a type III defect. We undertook external repair, placing a plug of Teflon felt into the cavity of the rupture and sandwiching it into place with pledgeted mattress and figure-of-8 sutures. The space occupied by the plug decreased the distance needed to obliterate the defect and thereby reduced the tension on the sutures necessary to achieve hemostasis. This simple technique enabled closure of the defect and avoided collateral tears that would have compromised an otherwise successful repair. Two years postoperatively, the patient had normal mitral valve function and no left ventricular aneurysm. In addition to reporting the patient's case, we review the types of left ventricular rupture that can occur during mitral valve replacement and discuss the various repair options.

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Paul Dagum ◽  
Tomasz A. Timek ◽  
G. Randall Green ◽  
David Lai ◽  
George T. Daughters ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Color Doppler ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Free System ◽  
Ring Annuloplasty ◽  
3D Geometry ◽  
Valve Function ◽  
Valve Dynamics ◽  
Radiopaque Markers

Background —The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results —Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8±2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions —This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

Abstract 14338: Prevalence, Associations and Outcomes of Double Orifice and Parachute Mitral Valve

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
uzoma obiaka ◽  
Anna Chow ◽  
Jen Lie Yau ◽  
Valeria Matto Morina ◽  
Shubhika Srivastava
Keyword(s):  
Mitral Valve ◽  
Age At Diagnosis ◽  
Text Search ◽  
Associated Lesions ◽  
Significant Difference ◽  
Parachute Mitral Valve ◽  
Valve Function ◽  
Echocardiographic Images ◽  
Double Orifice

Background: The incidence of congenital mitral valve disease is 0.4%; Double Orifice Mitral Valve (DOMV) and Parachute Mitral Valve (PMV) are two morphologic pathologies that may result in mitral valve dysfunction. The objectives of this study are 1) To describe valve function and progression and 2) To define factors contributing to disease progression. Methods: Retrospective database review. Fyler codes for DOMV, PMV and text search was performed. Echocardiographic images, echo reports, and chart review were used to identify mitral regurgitation (MR), mitral stenosis (MS), morphology, and associated lesions. Results: 39 patients with DOMV and 76 patients with PMV were identified. In the DOMV cohort, 51% were male, median age at diagnosis was 0.17 years (IQR 0.01, 3.88); median follow-up of 5.92 years (IQR 0.46, 10.22). In the PMV cohort, 44% were male, median age at diagnosis at was 0.01 years (IQR 0, 0.34); median follow-up of 2.56 years (IQR 0.25, 9.55). 41% of DOMV and 23% of patients with PMV had normal valve function at initial visit. DOMV was associated with MR (p=0.04), and PMV with MS (p<0.0001). 23% of patients in the PMV cohort had progressive MS compared to 5% of patients in the DOMV cohort (p<0.0001). There was no significant difference in MR progression between both groups (p=0.02). Papillary muscle (PM) morphology was evaluated in 37 (excluding canals) of 76 patients in the PMV cohort. 5 had true PMV (single PM), 32 had variant PMV with two PM groups of which 62.5% had dominant posterior medial PM. 67% of those with posterior medial PM dominance had progressive MS irrespective of association with Shone’s complex. The anterolateral PM muscle group dominant PMV were not associated with Shone’s complex and progressive MS. Conclusion: DOMV are more likely to have MR while PMV are more likely to have MS. DOMV has non progressive MR and MS. Posterior medial PM dominance in PMV is more likely to have progressive MS.

485 Novel Insights Into the Effect of Loading Conditions and Inotropy on Mitral Valve Function

2012 ◽  
Vol 28 (5) ◽  
pp. S278
Author(s):  
S. Dhillon ◽  
T. Colon ◽  
N. Khoo ◽  
J. Tyberg ◽  
C. Kroeker ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Loading Conditions ◽  
Valve Function

Non-Invasive Assessment of Prosthetic Mitral Valve Function

1975 ◽  
pp. 102-102
Author(s):  
Ruth Ann Smith ◽  
Richard E. Kerber ◽  
James W. Snyder
Keyword(s):  
Mitral Valve ◽  
Non Invasive ◽  
Valve Function ◽  
Prosthetic Mitral Valve
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