CT-Determined Tricuspid Annular Dilatation Is Associated With Increased 2-Year Mortality in TAVR Patients

Surgical implantation of a complete or incomplete ring to reduce the valve annulus and improve leaflet coaptation is the mainstay of mitral valve surgery. The Cardioband® system (Edwards Lifesciences, Irvine, CA, USA) was designed to address the pathophysiological mechanism of annular dilatation through a catheter-based approach. We present the histopathological workup of a Cardioband® device, which had been implanted 21 months earlier in a 34-year-old male with ischemic cardiomyopathy. Device examination demonstrate a well-positioned and securely anchored device. The described tissue reactions may have an impact on choice of device and timing in case of re-do surgery.

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POSSIBLE MECHANISM OF LATE SYSTOLIC MITRAL VALVE PROLAPSE: SYSTOLIC SUPERIOR SHIFT OF LEAFLETS SECONDARY TO ANNULAR DILATATION THAT TRACTS PAPILLARY MUSCLE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32208-9 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1602

Author(s):

Soshi Hei ◽

Mai Iwataki ◽

Takeshi Onoue ◽

Yasufumi Nagata ◽

Yutaka Otsuji

Keyword(s):

Mitral Valve ◽

Papillary Muscle ◽

Mitral Valve Prolapse ◽

Annular Dilatation

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Reexamining remodelling in children

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz380 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1091-1097

Author(s):

Shunsuke Matsushima ◽

Alexander Heß ◽

Julia Renata Lämmerzahl ◽

Irem Karliova ◽

Christian Giebels ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Connective Tissue Diseases ◽

Graft Size ◽

Effective Height ◽

Annular Dilatation ◽

Increased Risk ◽

Median Diameter ◽

The Mean

Abstract OBJECTIVES Some studies have suggested that root remodelling is unsuitable as valve-sparing aortic root replacement in children because of the increased risk of valve failure. This study reviewed our experience with root remodelling in children. METHODS All patients who underwent root remodelling at the age of ≤18 years between 1999 and 2016 were evaluated. In 2004, cusp effective height was measured intraoperatively and prolapse was corrected with central plication on the cusp. Suture annuloplasty was introduced after 2009 for annular dilatation. RESULTS There were 17 consecutive patients. The median age at operation was 14 (2.8–18) years. Aortic valve morphology was tricuspid in 10 patients, bicuspid in 5 patients, unicuspid in 1 patient and a pulmonary autograft in 1 patient. Marfan syndrome, Loeys-Dietz syndrome and other connective tissue diseases were present in 11, 1 and 2 patients, respectively. Five patients had more than moderate aortic regurgitation. The median graft size used for root remodelling was 24 (18–26) mm. Cusp repair and annuloplasty were performed in 15 and 14 patients, respectively. The mean follow-up time was 6.5 ± 4.3 years. One patient with preoperatively severely depressed ventricular function died in the hospital from persistent heart failure. One patient (operated on before 2004) required aortic valve reoperation due to cusp prolapse. One patient with a unicuspid valve had developed moderate aortic regurgitation, and the other 14 patients had mild or less regurgitation. The median diameter of the sinus of Valsalva at the last follow-up was 36 (30–43) mm, Z-score of 1.5 (−3.5 to 3.9). CONCLUSIONS Root remodelling can be performed in children with favourable results by appropriate cusp repair and annuloplasty.

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Atrial functional mitral regurgitation: mechanisms and surgical implications

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320941388 ◽

2020 ◽

Vol 28 (7) ◽

pp. 421-426

Author(s):

Yiting Fan ◽

Song Wan ◽

Randolph Hung-Leung Wong ◽

Alex Pui-Wai Lee

Keyword(s):

Mitral Regurgitation ◽

Left Ventricular ◽

Ventricular Dilatation ◽

Functional Mitral Regurgitation ◽

Current Evidence ◽

Disease Entity ◽

Risk Of Death ◽

Left Ventricular Dilatation ◽

Annular Dilatation ◽

Increased Risk

The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitral regurgitation is associated with increased risk of death and heart failure re-hospitalization. The etiology, pathophysiology, and mechanism of atrial functional mitral regurgitation is not completely understood but they should not be regarded as the same as for the conventional type of functional mitral regurgitation secondary to left ventricular dilatation and dysfunction. Mitral annular dilatation, atriogenic leaflet distortion, insufficient leaflet remodeling, and subtle left ventricular dysfunction may play a role in the pathogenesis of atrial functional mitral regurgitation. The therapeutic and surgical considerations of atrial functional mitral regurgitation are different from those of ventricular functional mitral regurgitation. In this review, we assess current evidence regarding this new disease entity and propose a new surgical approach based on up-to-date understanding and experience of this condition.

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Three-Dimensional Assessment of Left Ventricular Geometry and Annular Dilatation Provides New Mechanistic Insights into the Surgical Correction of Ischemic Mitral Regurgitation

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2006-924435 ◽

2006 ◽

Vol 54 (7) ◽

pp. 452-458 ◽

Cited By ~ 4

Author(s):

R. De Simone ◽

I. Wolf ◽

R. Hoda ◽

B. Mikhail ◽

S. Mottl-Link ◽

...

Keyword(s):

Mitral Regurgitation ◽

Three Dimensional ◽

Left Ventricular ◽

Surgical Correction ◽

Ischemic Mitral Regurgitation ◽

Left Ventricular Geometry ◽

Ventricular Geometry ◽

Annular Dilatation ◽

Dimensional Assessment

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000124 ◽

2015 ◽

Vol 10 (1) ◽

pp. 27-32 ◽

Cited By ~ 2

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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