scholarly journals Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation☆

2005 ◽  
Vol 27 (5) ◽  
pp. 847-853 ◽  
Author(s):  
Jerry Braun ◽  
Jeroen J. Bax ◽  
Michel I.M. Versteegh ◽  
Pieter G. Voigt ◽  
Eduard R. Holman ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Mitral Annuloplasty ◽  
Left Ventricular Dimensions ◽  
Ventricular Dimensions

Abstract 2265: Injection of a Biomaterial Polymer Results in Reverse Remodeling of Displaced Papillary Muscles and Reduction in Acute Ischemic Mitral Regurgitation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Judy Hung ◽  
Jorge Solis ◽  
J. L Guerrero ◽  
Gavin Braithwaite ◽  
Orhun K Muratoglu ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Inert Material ◽  
Stroke Work ◽  
Polymer Injection ◽  
Vena Contracta ◽  
Lv Remodeling

Ischemic mitral regurgitation (IMR) relates to papillary muscle (PM) displacement caused by left ventricular (LV) distortion. We tested the hypothesis that displaced PMs can be repositioned by injection of polyvinyl-alcohol (PVA) polymer, a biologically inert material specially formulated to produce an encapsulated, stable, resilient gel once injected into the myocardium. The aim is to alter the compliance of infarcted myocardium and realign the displaced PMs. Methods : 9 sheep underwent circumflex branch ligation to produce acute IMR. PVA polymer was then injected by echo guidance into the myocardium underlying the infarcted PM. Hemodynamic data, EF, Elastance (Emax), preload-recruitable stroke work (PRSW), relaxation constant tau, and echo data were measured post IMR and post PVA injection. Results : One animal died after coronary ligation and 2 had no IMR; MR was moderate in the remaining 6. PVA injection decreased MR vena contracta from 5±0.4mm to 2±0.7mm (p<0.0001), with decreased tethering distance from infarcted PM to mitral annulus (27±4 to 24±4mm, p<0.001). PVA injection did not significantly decrease EF (43±6% vs 37±4%, post IMR vs post PVA, p=ns), Emax (1.5±0.53 vs 1.6±0.42), PRSW (33±12 vs 31±5) or tau (63±49 ms vs 70±25 ms). Conclusions : PVA polymer injection can acutely reverse LV remodeling to reposition displaced PMs and decrease IMR without adverse effects on LV systolic or diastolic function. This new approach (to alter pathologic anatomy) offers an alternative for relieving IMR by correcting PM position, thus relieving tethering that causes IMR.

Abstract 1764: Coapsys ® Leads to Global Reversal of Left Ventricular Remodeling: Expanded TRACE Study Analysis

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sanjay Mittal ◽  
Yugal Mishra ◽  
Naresh Trehan
Keyword(s):  
Ventricular Remodeling ◽  
Shape Change ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Lv Dysfunction ◽  
Patients With Heart Failure ◽  
Lv Remodeling ◽  
Left Ventricular Dimensions ◽  
Ventricular Dimensions

Background: . We have previously reported as a part of the TRACE study that patients with LV dysfunction undergoing CABG and surgical implantation of Coapsys had significant reductions in LV size and MR at 1 year. Echo data of patients who recieved CABG with and without Coapsys, were retrospectively analyzed to determine the extent and pattern of LV reverse remodeling related to the LV shape change properties of Coapsys. Methods: Coapsys consists of anterior and posterior epicardial pads connected by a flexible chord, drawn together to affect change in valvular and ventricular geometry. Coapsys was implanted in patients whose MR remained ≥ grade 2 after CABG (Coapsys + CABG group, n=32). Patients whose MR grade reduced to 1 or less after CABG (CABG Alone group, n=35) received CABG only. Baseline age, ejection fraction, graft number, and MR grade in the Coapsys + CABG group and the CABG Alone group were 58, 35, 2.7, 3.0 and 59, 37 2.8, 2.7 respectively. Detailed echocardiographic measurements of diastolic left ventricular dimensions in 3 echo planes, 4 Chamber (4 Ch), 2 Chamber (2 Ch), and Long Axis (LAX), along with LV length and anterolateral papillary muscle (ALPM) depth were serially collected up to 12 months after surgery. Results: Comparison of baseline, 3 month and 12 month dimensions between Coapsys + CABG and CABG Alone groups are displayed in Figure 1 . Conclusions: In patients with MR and LV dysfunction undergoing implantation of Coapsys along with CABG, there is significant, global and progressive reversal of LV remodeling. This may to be related to the LV shape change properties of Coapsys and could benefit patients with heart failure.

scholarly journals Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient?

2020 ◽  
Vol 23 (3) ◽  
pp. E370-E375
Author(s):  
Hunbo Shim ◽  
Ji-won Hwang ◽  
Won-Sang Chung ◽  
Chun Ki Kim ◽  
Byung Jo Park ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Systolic Volume ◽  
One Year

Background: The progress of mild ischemic mitral regurgitation (MR) after isolated coronary artery bypass is not clear. We aimed to determine the proportion of patients with mild ischemic MR undergoing isolated coronary artery bypass grafting (CABG) presenting with regression of or persistent MR one year after CABG and to identify the significantly different echocardiographic variables between regressing and persistent MR. Methods: Sixty-three patients with preoperative mild ischemic MR were categorized into an MR-regression or an MR-persistence group one year after isolated CABG. The echocardiographic indices, indicating mitral leaflet configuration and remodeling of the left ventricle (LV), were measured before and one year after the surgery. Results: One year after CABG, MR regressed in 60% (38/63) and persisted in 40% (25/63) of the patients. The left ventricular diameter, volume, and sphericity and anteroposterior diameter of the mitral annulus improved only in the MR-regression group, while the ejection fraction improved in both groups (47.7% ± 12.4% from 40.1% ± 11.3%, P < .001 in the regression group and 43.2% ± 14.0% from 39.3% ± 11.6%, P = .035 in the persistence group). A >15% decrease in the LV end-systolic volume was noted more frequently in the MR-regression group (60.5% versus 30%, P = .027). The leaflet angle did not show asymmetry or significant changes in both groups. Conclusions: Isolated CABG improved mild MR in most patients with mild ischemic MR. These patients showed greater reverse remodeling after revascularization than the patients with persistent MR after isolated CABG. Additional tests, which can predict LV reverse remodeling, are needed to predict persistent MR.

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