scholarly journals Acute Effect of Mitral Valve Repair on Mitral Valve Geometry

2018 ◽  
Vol 67 (07) ◽  
pp. 516-523 ◽  
Author(s):  
Thilo Noack ◽  
Kathleen Wittgen ◽  
Philipp Kiefer ◽  
Fabian Emrich ◽  
Matthias Raschpichler ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cardiac Cycle ◽  
Morphological Changes ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Acute Effect ◽  
Dynamic Changes ◽  
4D Imaging ◽  
Ring Annuloplasty ◽  
Before And After

Background The aim of this study was to quantify acute mitral valve (MV) geometry dynamic changes throughout the cardiac cycle using three-dimensional transesophageal echocardiography (3D TEE) in patients undergoing surgical MV repair (MVR) with ring annuloplasty and optional neochord implantation. Methods Twenty-nine patients (63 ± 10 years) with severe primary mitral regurgitation underwent surgical MVR using ring annuloplasty with or without neochord implantation. We recorded 3D TEE data throughout the cardiac cycle before and after MVR. Dynamic changes (4D) in the MV annulus geometry and anatomical MV orifice area (AMVOA) were measured using a novel semiautomated software (Auto Valve, Siemens Healthcare). Results MVR significantly reduces the anteroposterior diameter by up to 38% at end-systole (36.8–22.7 mm; p < 0.001) and the lateromedial diameter by up to 31% (42.7–30.3 mm; p < 0.001). Moreover, the annular circumference was reduced by up to 31% at end-systole (129.6–87.6 mm, p < 0.001), and the annular area was significantly decreased by up to 52% (12.8–5.7 cm2; p < 0.001). Finally, the AMVOA experienced the largest change, decreasing from 1.1 to 0.2 cm2 during systole (at midsystole; p < 0.001) and from 4.1 to 3.2 cm2 (p < 0.001) during diastole. Conclusions MVR reduces the annular dimension and the AMVOA, contributing to mitral competency, but the use of annuloplasty rings reduces annular contractility after the procedure. Surgeons can use 4D imaging technology to assess MV function dynamically, detecting the acute morphological changes of the mitral annulus and leaflets before and after the procedure.

In Vivo Dynamic Strains of the Mitral Valve Annulus

2007 ◽  
Author(s):  
Brett Zubiate ◽  
Michael Sacks ◽  
Robert C. Gorman ◽  
Joseph H. Gorman
Keyword(s):  
Mitral Valve ◽  
Cardiac Cycle ◽  
Dimensional Space ◽  
Complex Structure ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Mitral Valve Leaflet ◽  
Valve Function ◽  
Integrated Operation

The mitral valve apparatus is a complex structure with multiple components that require seamless, integrated operation for normal valve function. One of these components is the annulus, a fibrous ring of tissue that defines the boundary between the mitral valve leaflets and the surrounding superstructure of the heart. During the cardiac cycle the annulus undergoes large deformations and dramatic shape changes. Moreover, the annulus motion represents a key boundary condition for mitral valve leaflet deformation. Yet, to date our knowledge of the subtle deformations this structure undergoes during the cardiac cycle remains very limited. In the present study, an array of 1 mm diameter piezoelectric sonocrystals was implanted in 5 sheep to quantify annular deformation over the complete cardiac cycle. These crystals act as fiducial markers for the mitral annulus with a temporal resolution of ∼1ms and a special resolution of .01mm in a calibrated three dimensional space. A quintic order generalized 3D spline was developed to reconstruct the annular geometry.

scholarly journals The Impact of a New “Inverted Arch” Prosthetic Annuloplasty Ring on the Mitral Valve’s 3-D Motion: An Experimental Ex-Vivo Study

2019 ◽  
Vol 6 (2) ◽  
pp. 31
Author(s):  
Philippe Caimmi ◽  
Emmanouil Kapetanakis ◽  
Carla Beggino ◽  
Giovanni Vacca ◽  
Elena Grossini ◽  
...  
Keyword(s):  
Cardiac Cycle ◽  
Ex Vivo ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Distance Measurements ◽  
Before And After ◽  
The Impact ◽  
Ex Vivo Study

This experimental study aimed to evaluate the ex-vivo three-dimensional (3-D) motion of the Inverted Arch Ring (IAR), an innovative new design concept for a flexible incomplete annuloplasty prosthesis with an incorporated stabilizing rigid arch that can be used in correcting mitral valve regurgitation. Twenty explanted porcine hearts were placed in a circulation simulation system. Ultrasonometry transducers implanted in the mitral annulus were used to measure the 3-D valvular motion during a simulated cardiac cycle. Annular distance measurements were recorded and compared in each heart before and after the implantation of the IAR prosthesis at pressures corresponding to mid-systole and mid-diastole. Distances measured in mid-systole and mid-diastole demonstrated no significant differences in annular motion or in valve areas either prior to or after IAR implantation. Therefore, the results of this study confirm the minimal effects exerted by the IAR prosthesis on the mitral valve’s 3-D motion during a simulated cardiac cycle.

scholarly journals Morphological Evaluation of Mitral Valve Based on Three-dimensional Printing Models: Potential Implication for Mitral Valve Repair

2021 ◽  
Author(s):  
Yuanting Yang ◽  
Hao Wang ◽  
Hongning Song ◽  
Yugang Hu ◽  
Qincheng Gong ◽  
...  
Keyword(s):  
Mitral Valve ◽  
3D Printing ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Water Soluble ◽  
Valve Repair ◽  
Potential Implication ◽  
Before And After

Objective: This study aimed to analyze the morphological characteristics of rheumatic (RMVD) and degenerative mitral valve diseases (DMVD) based on three-dimensional (3D) printing model before and after surgery and to explore the potential implication of the 3D printing model for mitral valve (MV) repair.Methods: 3D transesophageal echocardiography (TEE) data of the MV were acquired in 45 subjects (15 with RMVD, 15 with DMVD, and 15 with normal MV anatomy). 3D printing models of the MV were constructed by creating molds to be printed with water-soluble polyvinyl alcohol, then filled with room temperature vulcanizing silicone. The parameters of the annulus and leaflet of the MV were acquired and analyzed using the 3D printing model. Mitral valve repair was simulated on 3D printing models of 10 subjects and compared with the actual operation performed on patients. The effects of surgery were assessed by evaluating the changes in coaptation length (CL) and the annular height to commissural width ratio (AHCWR) before and after MV repairs. The correlations of the grade of mitral regurgitation with CL and AHCWR were analyzed.Results: 3D silicone MV models were all successfully constructed based on 3D TEE data. Compared with the normal groups, the mitral annulus size in the RMVD groups showed no significant differences. In contrast, mitral annulus in DMVD groups was dilated and flattened with diameters of anteroposterior, anterolateral-posteromedial, commissural width, annular circumferences, and area increased. Mitral repair was successfully simulated on 10 models with significant increase in leaflet coaptation area both in vivo and in vitro. Good agreement was observed in CL and AHCWR after surgery in the 3D printing model compared with real surgery on the patient valve. The grade of mitral regurgitation correlated inversely with CL (r &#x003D; &#x2013;0.87, P &#x003C; 0.01) and AHCWR (r &#x003D; &#x2013;0.79, P &#x003C; 0.01). Mitral valve repair was performed twice in one model to assess which provided a better outcome.Conclusions: 3D printing models of the MV based on 3D TEE data could be used in morphological analysis of the MV before and after surgery in RMVD and DMVD. Surgery simulation on 3D printing models could provide valuable information concerning morphological changes after surgery, with are closely associated with clinical outcomes.

scholarly journals Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence

2021 ◽  
Vol 8 (2) ◽  
pp. 9
Author(s):  
Nina C. Wunderlich ◽  
Siew Yen Ho ◽  
Nir Flint ◽  
Robert J. Siegel
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Morphological Changes ◽  
Morphological Characteristics ◽  
Mitral Annulus ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Myocardium ◽  
Basal Portion

The morphological changes that occur in myxomatous mitral valve disease (MMVD) involve various components, ultimately leading to the impairment of mitral valve (MV) function. In this context, intrinsic mitral annular abnormalities are increasingly recognized, such as a mitral annular disjunction (MAD), a specific anatomical abnormality whereby there is a distinct separation between the mitral annulus and the left atrial wall and the basal portion of the posterolateral left ventricular myocardium. In recent years, several studies have suggested that MAD contributes to myxomatous degeneration of the mitral leaflets, and there is growing evidence that MAD is associated with ventricular arrhythmias and sudden cardiac death. In this review, the morphological characteristics of MAD and imaging tools for diagnosis will be described, and the clinical and functional aspects of the coincidence of MAD and myxomatous MVP will be discussed.

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.

New Stent for Transapical Mitral Valve Replacement in Acute Swine Experiment

2020 ◽  
Author(s):  
Yu Zou ◽  
Peng Teng ◽  
Liang Ma
Keyword(s):  
Mitral Valve ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Annulus ◽  
The Self ◽  
Purse String ◽  
Transcatheter Mitral Valve Replacement ◽  
Before And After ◽  
The Mean

Abstract Background: Many patients with mitral regurgitation are denied open-heart surgery due to high risk. Transcatheter mitral valve replacement offers an alternative treatment. This study aimed to test the feasibility of a new self-expanding valved stent for transcatheter mitral valve replacement via apex in an acute animal model.Methods: Eight porcine experiments were performed in the acute study. A left thoracotomy was performed. The new self-expanding transcatheter valved stent was deployed under fluoroscopic guidance within the native mitral annulus via apex. Hemodynamic data, before and after implantation, were recorded. Mitral annulus diameter and valve area were measured using echocardiography. Transvalvular and left ventricular outflow tract pressure gradient were measured invasively. Results: Seven animals underwent successful transapical mitral valve replacement; the implantation was unsuccessful in one animal. The mean procedure time, defined from placing the purse-string to tightening the purse-string, was 17.14 ± 7.86 min. Hemodynamic data before and after transapical mitral valve replacement showed no difference in statistical analysis. The mean diameter and mean functional area of the self-expanding device after implantation were 2.58 ± 1.04 cm and 2.70 ± 0.26 cm2, respectively. Trace to mild central and paravalvular leak was detected in 7 valves. Mean pressure gradient across the self-expanding device was 2.00 ± 0.82 mm Hg; the corresponding gradients across the LVOT were 3.28± 1.11 mm Hg. Postmortem examinations confirmed precise device positioning in 7 animals with no signs of LVOT obstruction.Conclusion: Transcatheter mitral replacement of the new valved stent was confirmed feasible in acute preclinical models. The new stent reveals optimal design parameters.

scholarly journals Mitral valve opening in the ovine heart

1998 ◽  
Vol 274 (2) ◽  
pp. H552-H563 ◽  
Author(s):  
Matts O. Karlsson ◽  
Julie R. Glasson ◽  
Ann F. Bolger ◽  
George T. Daughters ◽  
Masashi Komeda ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Rapid Fall ◽  
Valve Opening ◽  
Radiopaque Markers ◽  
Edge Separation ◽  
Central Cusp

To study the three-dimensional size, shape, and motion of the mitral leaflets and annulus, we surgically attached radiopaque markers to sites on the mitral annulus and leaflets in seven sheep. After 8 days of recovery, the animals were sedated, and three-dimensional marker positions were measured by computer analysis of biplane videofluorograms (60/s). We found that the oval mitral annulus became most elliptical in middiastole. Both leaflets began to descend into the left ventricle (LV) during the rapid fall of LV pressure (LVP), before leaflet edge separation. The anterior leaflet exhibited a compound curvature in systole and maintained this shape during opening. The central cusp of the posterior leaflet was curved slightly concave to the LV during opening. Markers at the border of the “rough zone” were separated by 10 mm during systole. We conclude that coaptation occurs very near the leaflet edges, that the annulus and leaflets move toward their open positions during the rapid fall of LVP, and that leaflet edge separation, the last event in the opening sequence, occurs near the time of minimum LVP.

Comparison of the sustainability of mitral annular dynamics between two semi-rigid annuloplasty devices

2019 ◽  
Vol 56 (2) ◽  
pp. 360-368 ◽  
Author(s):  
Stefaan Bouchez ◽  
Frank Timmermans ◽  
Tine Philipsen ◽  
Katrien François ◽  
Thierry Bové
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Cardiac Cycle ◽  
3D Structure ◽  
Mitral Annulus ◽  
Width Ratio ◽  
Valve Repair ◽  
Postoperative Changes ◽  
Folding Dynamics ◽  
Saddle Shape

Abstract OBJECTIVES The choice of annuloplasty device is fundamental at the time of mitral valve repair, the goal being to optimally restore the physiological 3-dimensional (3D) structure and dynamics of the mitral annulus (MA). This study evaluated MA dynamics after annuloplasty with 2 different semi-rigid devices. METHODS Thirty-three patients eligible for mitral valve repair were selected for annuloplasty with the Physio II ring (Edwards Lifesciences, Irving, CA, USA) (n = 17) or the Memo 3D ring (LivaNova, Saluggia, Italy) (n = 16). MA dynamics were assessed with transoesophageal 3D echocardiography intraoperatively and 1 year after repair. RESULTS The postoperative changes in the anteroposterior diameter {3.7% [standard deviation (SD) 2.7] vs 1.9% [SD 1.3]; P = 0.013} and in the annular height [27.7% (SD 8.7) vs 18.0% (SD 13.9); P = 0.003] were significantly larger with the Memo 3D ring during the cardiac cycle. The restoration of the saddle shape at baseline was superior with the Physio II ring, defined by a larger systolic annular height-to-commissural width ratio [15.1% (SD 2.3) vs 7.1% (SD 2.4); P < 0.001]. These observations of MA dynamics were sustained after 1 year, shown by a greater anteroposterior extension [5.1% (SD 1.0) vs 1.7% (SD 1.6); P = 0.002] and change in annular height-to-commissural width ratio [15.7% (SD 12.7) vs 3.1% (SD 3.0); P = 0.020] for the Memo 3D ring. There were no significant differences in mitral valve function between the 2 devices. CONCLUSIONS The MA dynamics after annuloplasty with the Physio II and Memo 3D rings demonstrated a better systolic 3D restoration of the saddle shape with the Physio II ring, whereas the saddle-shaped geometry improved significantly with the Memo 3D ring, as a dynamic phenomenon. The Memo 3D ring also showed increased anteroposterior annular mobility and folding dynamics throughout the cardiac cycle. Moreover, the observed differences in MA dynamics between both devices appeared to be sustainable 1 year after ring implantation.

Abstract 17214: Prediction of Mitral Valve Repair: Pre-Repair versus Virtual Repair versus Post-Repair

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
MyungGu Yeo ◽  
Tom T Nguyen ◽  
David D McPherson ◽  
Hyunggun Kim
Keyword(s):  
Mitral Valve ◽  
Surgical Planning ◽  
Patient Specific ◽  
Valve Repair ◽  
Repair Strategy ◽  
Dynamic Finite Element ◽  
Ring Annuloplasty ◽  
Before And After ◽  
Leaflet Coaptation ◽  
Leaflet Prolapse

Introduction: Partial leaflet resection followed by ring annuloplasty is a reliable and reproducible mitral valve (MV) repair technique for the treatment of severe mitral regurgitation (MR) due to posterior chordal rupture. Hypothesis: We have developed a novel computational virtual MV repair strategy to predict the biomechanical and physiologic characteristics of post-repair MV dynamics to help with optimal surgical planning. Methods: Computational MV models were created using pre- and post-repair 3D echocardiographic data of a patient having posterior chordal rupture and severe MR. Virtual resection was designed by removing a pre-defined triangle-shaped leaflet portion in the P2 scallop and merging the excised leaflet edges. Virtual ring annuloplasty with the same ring size as the post-repair MV was performed following the triangular leaflet resection. Computational simulations of MV function (pre-repair, virtual repair, and post-repair) were performed using dynamic finite element methods. Leaflet coaptation across the MVs were quantitatively determined and compared. Results: The pre-repair MV with P2 chordal rupture showed severe P2 prolapse and leaflet malcoaptation. The post-repair MV demonstrated markedly reduced prolapse and sufficiently restored leaflet coaptation. The virtually repaired MV revealed a similar coaptation ratio as the post-repair MV indicating effective restoration of normal MV function. Both virtual repair and post-repair MVs showed improved coaptation not only in the P2 region but also in the A1-P1 and A3-P3 regions. Conclusions: We have quantitatively evaluated patient-specific MV function before and after potential MV repair using a novel virtual MV repair protocol. Both virtual repair and post-repair MVs decreased posterior leaflet prolapse and restored normal coaptation. This virtual MV repair strategy has the potential for improved pre-surgical planning to predict and optimize post-repair MV function.

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