Prediction for residual regurgitation after MitraClip for functional mitral regurgitation using leaflet coaptation index

2020 ◽  
Vol 35 (12) ◽  
pp. 3555-3559
Author(s):  
Hunbo Shim ◽  
Morgan Harloff ◽  
Edward Percy ◽  
Sameer Hirji ◽  
Pinak B. Shah ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Leaflet Coaptation

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.

Severe Functional Mitral Regurgitation with Missing Leaflet Coaptation

2012 ◽  
pp. 443-447
Author(s):  
Antti Saraste ◽  
Juha Lund ◽  
Markku Saraste ◽  
Matti Luotolahti ◽  
Juhani Airaksinen ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Leaflet Coaptation

EFFECT OF PAPILLARY MUSCLE DISPLACEMENT AND ANNULAR DILATION ON DEVELOPMENT OF FUNCTIONAL MITRAL REGURGITATION

2018 ◽  
Vol 18 (07) ◽  
pp. 1840020
Author(s):  
WOOJAE HONG ◽  
HYUNGGUN KIM
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Lv Dysfunction ◽  
Simulation Based ◽  
Normal Human ◽  
Biomechanical Evaluation ◽  
Normal Mitral Valve ◽  
Annular Dilation ◽  
Leaflet Coaptation

Functional mitral regurgitation (FMR) occurs following left ventricle (LV) dysfunction with normal mitral valve (MV) leaflet. The progress and severity of FMR are closely related to LV dilatation, which often results in displacement of the papillary muscles (PMs) and enlargement of the mitral annulus. We investigated the effect of PM displacement and annular dilation on FMR development to better understand the complex intercorrelation between these pathologic alterations leading to FMR. Virtual MV modeling was performed to create a normal human MV, and several different types of PM displacement, annular dilation, and the combination of PM displacement and annular dilation mimicking the pathology of FMR were modeled. Dynamic finite element evaluation of MV function was performed across the complete cardiac cycle for the normal and FMR MV models. PM displacement to both lateral and apical directions revealed markedly reduced leaflet coaptation and large stress distribution in the P2 scallop. Annular dilation greater than 2% demonstrated the occurrence of leaflet malcoaptation and increased stresses near the anterior saddle-horn region. The pathologic MV model with annular dilation combined with PM displacement provides physiologically realistic biomechanical characteristics as the MVs having FMR. Simulation-based biomechanical evaluation of MV pathology related to LV chamber dilatation provides an excellent tool to better understand the pathophysiologic mechanism of FMR.

scholarly journals Mitraclip therapy in patients with functional mitral regurgitation and missing leaflet coaptation: is it still an exclusion criterion?

2016 ◽  
Vol 18 (10) ◽  
pp. 1278-1286 ◽  
Author(s):  
Marianna Adamo ◽  
Ermanna Chiari ◽  
Salvatore Curello ◽  
Cristian Maiandi ◽  
Giuliano Chizzola ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Exclusion Criterion ◽  
Leaflet Coaptation ◽  
Mitraclip Therapy

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

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.

A Novel Technique for Functional Mitral Regurgitation Therapy: Mitral Annular Remodeling

2006 ◽  
Vol 9 (6) ◽  
pp. E888-E892 ◽  
Author(s):  
Keiji Kamohara ◽  
Michael Banbury ◽  
Anthony Calabro ◽  
Zoran B. Popović ◽  
Aniq Darr ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Novel Technique

Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

2013 ◽  
Vol 16 (5) ◽  
pp. E295-E297 ◽  
Author(s):  
Joseph Lamelas ◽  
Christos Mihos ◽  
Orlando Santana
Keyword(s):  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Rational Approach ◽  
Functional Mitral Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Mitral Annuloplasty ◽  
Technical Details ◽  
Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

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