Abstract 16994: Left Ventricle Accessory Antero-Septal Papillary Muscle Detected in the LVOT Vicinity by Means of Cardiac MRI and Echocardiography in HOCM and Control Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
George O Angheloiu ◽  
Robert W Biederman
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Cardiac Mri ◽  
Physiological Significance ◽  
Accessory Muscle ◽  
Early Systole ◽  
And Control

Background: We studied by means of echocardiography (echo) and cardiac MRI the occurrence of an accessory papillary muscle that unites mostly the left ventricle (LV) apex with the basal or mid antero-septum. Methods: We included all good quality studies as reviewed by two cardiologists and assessed the occurrence of a contractile papillary muscle situated between the LV apex and antero-septum. Results: A contractile accessory papillary muscle situated between the LV apex and the antero-septum was seen in 100% of HOCM patients and 62% of control patients (p=0.05, panels 1-6 HOCM patients and 7-9 controls; panels 1, 4 and 7 - diastole; 2,5 and 8 - early-systole; 3, 6 and 9 - end-systole) in the cardiac MRI images acquired from a total of 22 HOCM (9) and control (13) patients. The same structure was observed in 241 patients representing 69.5% of all-comers echo studies. The age was 69 ± 17 years on average in the echo arm, patients harboring the antero-septal accessory muscle being older (71.6 + 15.7 years old vs 63.5 ± 18.1 for those without, p=0.0005). We exemplify this structure by parasternal long axis still echo images from 24 patients (panel 14) as well as more detailed images from 4 patients in the same group (panels 10-13). Red arrows point out the accessory antero-septal papillary muscle and white arrows the antero-septum. Pink and yellow dots neighbor the regular antero-lateral and postero-medial pap muscles and the white dots the mitral valve. Conclusion: A contractile accessory papillary muscle was observed in slightly more than half of the all-comer echo studies, and in all HOCM patients in the cardiac MRI arm. Further research is needed to fully characterize the anatomical and physiological significance of this structure attaching in the immediate vicinity of the LVOT in HOCM and control patients.

scholarly journals Reconstructive operations on subvalvular structures of the mitral valve during remodelling of the left ventricle. Papillary muscle interventions

2020 ◽  
Vol 24 (3) ◽  
pp. 32
Author(s):  
I. I. Skopin ◽  
M. S. Latyshev
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Conflict Of Interest ◽  
Reconstruction Technique ◽  
Type Iiib ◽  
Reconstructive Operations ◽  
Reverse Remodelling ◽  
Secondary Mitral Regurgitation

<p>The optimal treatment strategy for secondary mitral regurgitation of type IIIb (A. Carpentier classification) remains debatable. The use of a standard surgical technique for treating secondary mitral regurgitation and undersized ring annuloplasty demonstrates suboptimal results in several patients (about 30% of the patients exhibit postoperative hemodynamically significant mitral regurgitation with the absence of effective reverse remodelling of the left ventricle). Such suboptimal results are associated with the unification of only the mitral valve reconstruction technique, irrespective of the state of the left ventricle (degree of dysfunction, dilatation, tethering/tenting, and papillary muscle displacement); this is not entirely justified because of the disease complexity (valve and ventricular), and it is crucial to influence both the components of the disease. Particularly, modern researchers are inclined toward the need of using additional reconstructive interventions on the subvalvular structures that contribute to a more effective reverse remodelling of the left ventricle.<br />Here, we present a review of recent studies on the surgical treatment of functional mitral insufficiency of type IIIb (A. Carpentier classification) with effects on the subvalvular structures (pupillary muscle relocation and approximation).</p><p>Revised 19 April 2020. Revised 5 May 2020. Accepted 28 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals P1689 Mitral valve prolapse secondary to ischemic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Babur Guler ◽  
A Kilicgedik ◽  
H Zencirkiran Agus ◽  
G Kahveci
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Systolic Function ◽  
Systolic Pulmonary Artery Pressure ◽  
Mitral Prolapse

Abstract Introduction Mitral valve prolapse is the most common form of degenerative mitral valve disease. However, ischemic mitral valve prolapse is a rare cause of mitral regurgitation. The mechanism was initially thought to be papillary muscle dysfunction, but more complex mechanisms were suggested recently. Purpose Try to understand the pathophysiology of ischemic mitral valve prolapse on a case example. Case Report A 42-year-old male with a history of inferoposterior myocardial infarction was admitted from outpatient clinic due to NYHA class 3 heart failure symptoms. On physical examination, a 4/6 holosystolic murmur was heard in the apex. He had a permanent pacemaker implanted for sick sinus syndrome. Transthoracic echocardiography showed 1-global dysfunction of the left ventricle (posterior segment akinetic and thinned), 2- prolapse of the posterior mitral leaflet (suspicion of ruptured chordae) 3-severe mitral regurgitation (with anterior eccentric jet), 4- moderate tricuspid regurgitation and high systolic pulmonary artery pressure (65 mmHg), 5- pacemaker lead in the right heart chambers. 6- normal right ventricular systolic function. Transesophageal echocardiography showed P2 scallop prolapse and chordae were intact, there were no redundant or myxamous components of the leaflets. It was observed that the posteromedial papillary muscle was elongated and did not contract. We commented that these echocardiographic findings represented ischemic mitral valve prolapse. Other echo findings in favour of this hypothesis were the posteromedial papillary muscle prolongation in systole and reduced the free strain of papillary muscle in the the apical long axis view. The patient underwent mitral ring anuloplasty and surgical neocord implantation. Surgery also reported the aetiology as ischemic mitral prolapse secondary to chordal extension in accordance with echocardiography. Conclusion(s): Ischemic mitral prolapse is a complex pathology involving multiple components of the mitral valve apparatus as left ventricle, papillary muscle, chordae, annulus, leaflets. The diagnostic criteria for ischemic mitral valve prolapse and its management are not defined. The presence of myocardial infarction and the exclusion of other possible valve pathologies with transesophageal echocardiography are important steps in the diagnosis. Abstract P1689 Figure.

scholarly journals P1720 Hammock mitral valve, a challenging echocardiographic diagnosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Rodrigo Carbonero ◽  
U Estandia ◽  
C Perez ◽  
R Voces ◽  
P Perez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Valve Disease ◽  
Valve Prosthesis ◽  
Papillary Muscles ◽  
Rheumatic Valve Disease

Abstract We report a 43 year-old female with a past TTE echocardiography of rheumatic valve disease performed in her district hospital , ( No clear symptomatology of rheumatic fever in the past). She was transferred to our tertiary hospital for elective cardiac surgery. Preoperative echocardiogram showed a non-dilated left ventricle with preserved contractility, mild-moderate left atrium enlargement with severe mitral regurgitation and basal displacement of papillary muscles and severe tricuspid regurgitation.All of it resembling a hammock mitral valve instead of former echocardiogram described as rheumatic valve disease. Preoperative cardiac study showed severe pulmonary hypertension with increased pulmonary vascular resistances. Preserved biventricular cardiac output and increased proto and telesystolic pressures. During surgery , ifindings were described as a mitral valve with a large papillary muscle inserted in the distal third of the left ventricle with none tendinous cords at the anterior leaflet and without cords in the posterior leaflet with an isolated papillary muscle with cords at A3 and P3 scallops, compatible with hammock mitral valve. A tendinous muscle/fibrous or fibromuscular band connecting the septum to the posterior wall of the left ventricle was described. Moreover over, there was an enlarged tricuspid ring with very short tendinous cords on the septal leaflet, although the leaflet was bigger than usual. Surgery consisted of resection of the mitral valve preserving A3 and P3 scallops with a 29mm Bicarbon Sorin mechanical mitral prosthesis and a 32mm Carpentier tricuspid ring implantation and pulmonary veins ablation combined with occlusion of left atrial appendage. After 112 minutes of cross-clamping time, the patient was weaned from cardiopulmonary bypass. She had important left ventricle dysfunction which improved with dobutamine and AAI pacemaker at 90lpm. Postoperative TEE showed moderate dysfunction of right ventricle, mild left ventricular dysfunction, moderate tricuspid regurgitation and a good functioning of the prosthesis. TTE before discharge showed good function of mitral valve prosthesis, good left ventricle function, mild tricuspid regurgitation, mild-moderate right ventricular enlargement, although less than preoperatively. Conclusion Congenital mitral valulophaty is a rare condition in the adulthood. The estimated prevalence is 0,5%. The hammock mitral valve is a more uncommon pathology which affects the mitral valve and subvalvular apparatus. This anomaly, was first described in 1967 and it is characterised by anomalous papillary muscles directly connected to the anterior mitral valve by a fibrous bridge without chordae tendineae in between them. This fibrous bridge hampers the opening and closure of the mitral valve. Diagnosis requires a high index of suspicion, both ultrasound studies and medical history, to avoid misdiagnosis. Abstract P1720 Figure.

scholarly journals Euler’s Elastica-Based Biomechanics of the Papillary Muscle Approximation in Ischemic Mitral Valve Regurgitation: A Simple 2D Analytical Model

Materials ◽  
2019 ◽  
Vol 12 (9) ◽  
pp. 1518 ◽  
Author(s):  
Francesco Nappi ◽  
Angelo Rosario Carotenuto ◽  
Sanjeet Singh Avtaar Singh ◽  
Christos Mihos ◽  
Massimiliano Fraldi
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Pathological Condition ◽  
Heart Rhythm ◽  
Variable Degree ◽  
Chordae Tendineae ◽  
Left Ventricle Remodeling ◽  
Euler’S Elastica

Ischemic mitral regurgitation (IMR) occurs as an adverse consequence of left ventricle remodeling post-myocardial infarction. A change in mitral valve configuration with an imbalance between closing and tethering forces underlie this pathological condition. These abnormalities lead to impaired leaflet coaptation and a variable degree of mitral regurgitation, which can in turn influence the ventricular filling status, the heart rhythm and the afterload regardless of the residual ischemic insult. The IMR correction can be pursued through under-sizing mitral annuloplasty and papillary muscle approximation to restore the mitral valve and left ventricle physiological geometry to, consequently, achieve normalization of the engaged physical forces. Because the structures involved undergo extremely large deformations, a biomechanics model based on the Euler’s Elastica –the mitral leaflet– interlaced with nonlinear chordae tendineae anchored on papillary muscles has been constructed to elucidate the interactions between closing and tethering forces. The model takes into account the actual updated geometrical and mechanical features of the valvular and subvalvular apparatuses in physiological and IMR conditions, as well as in case of papillary muscle approximation, finally furnishing ad hoc geometry-based mathematical relations that could be utilised to support—and optimize—the relevant choices in cardiac surgery.

A Computational Study of a Thin-Walled Three-Dimensional Left Ventricle During Early Systole

1994 ◽  
Vol 116 (3) ◽  
pp. 307-314 ◽  
Author(s):  
Ajit P. Yoganathan ◽  
Jack D. Lemmon ◽  
Young H. Kim ◽  
Peter G. Walker ◽  
Robert A. Levine ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Numerical Study ◽  
Three Dimensional ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Model Parameters ◽  
Septal Wall ◽  
Early Systole ◽  
Thin Walled

A numerical study was conducted to solve the three-dimensional Navier-Stokes equations for time-dependent flow in a compliant thin-walled, anatomically correct left ventricle during early systole. Model parameters were selected so that the simulation results could be compared to clinical data. The results produced endocardial wall motion which was consistent with human heart data, and velocity fields consistent with those occurring in a normally-contracting left ventricle. During isovolumetric contraction the posterior wall moved basally and posteriorly, while the septal wall moved apically and anteriorly. During ejection, the short axis of the left ventricle decreased 1.1 mm and the long axis increased 4.2 mm. At the end of the isovolumetric contraction, most of the flow field was moving form the apex toward the base with recirculation regions at the small pocket formed by the concave anterior leaflet, adjacent to the septal wall and near the left ventricular posterior wall. Fluid velocities in the outflow tract matched NMR data to within 10 percent. The results were also consistent with clinical measurements of mitral valve-papillary muscle apparatus displacement, and changes in the mitral valve annular area. The results of the present study show that the thin-walled, three-dimensional left ventricular model simulates observed normal heart phenomena. Validation of this model permits further studies to be performed which involve altered ventricular function due to a variety of cardiac diseases.

Double- Chambered Left Ventricle and Abnormal Papillary Muscle Formation

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Ventricular Wall ◽  
Papillary Muscles ◽  
Rare Form ◽  
Mitral Valve Leaflet ◽  
Muscle Formation

Papillary muscles develop separately from mitral valve leaflet and chordae, they origin from myocardial ridge of the anterior wall and to the posterior wall of the left ventricle (LV). While chordae and mitral valve leaflets origin from a cushion tissue. The myocardial ridge gradually loosens from the ventricular wall and meanwhile the cushion tissue transforms into leaflet and chordae1. Abnormal papillary muscle formation may present a muscle bridge and divide the LV into two chambers. The most rare form is the superior inferior LV subdivision which our cases represent.

Left ventricular asynergy during intracoronary isoproterenol infusion in dogs

1980 ◽  
Vol 239 (5) ◽  
pp. H594-H600
Author(s):  
A. Ilebekk ◽  
J. Lekven ◽  
F. Kiil
Keyword(s):  
Heart Rate ◽  
Coronary Artery ◽  
Left Ventricle ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Early Systole ◽  
And Control ◽  
Isoproterenol Infusion ◽  
Inotropic Stimulation ◽  
Adrenergic Agent

Myocardial contractions were examined in the left ventricle of anesthetized, open-chest dogs during infusion of a beta-adrenergic agent, isoproterenol (0.1-0.5 micrograms/min) into a shunt line to the left anterior descending coronary artery. Myocardial chord lengths were continuously monitored by pairs of ultrasonic elements inserted into the isoproterenol-infused and control regions. Heart rate remained constant, but isoproterenol altered contraction patterns in both control and infused regions. Contraction in the infused region started before ejection and stretched the control myocardium in early systole. Because of early relaxation, however, the infusion region was stretched at the end of ejection and in early diastole, while the control myocardium continued to shorten. Thus, isoproterenol infusion to a part of the left ventricle induces asynergic muscle contractions and despite localized inotropic stimulation stroke volume may not be significantly increased.

Sign in / Sign up

Export Citation Format

Share Document