Premolded Bovine Pericardial Chords for Replacement of Ruptured or Elongated Chordae Tendineae

Background: The aim of this study was to assess by Doppler echocardiography (ECO) the functioning of the mitral valve apparatus in patients who have undergone implantation of standardized bovine pericardium chordae (SBPC) for replacement of ruptured or elongated chordae tendineae with significant thinning.Methods: SBPC were implanted in 31 patients who had mitral insufficiency due to rupture of chordae tendinae or elongated chordae with significant thinning. Patient ages ranged from 19 to 85 years (mean of 58 years). The most frequent cause of mitral insufficiency was fibroelastic degeneration in 25 patients (80.6%). The SBPC were fashioned as a set, joined at their extremities by 2 polyester-reinforced rods forming a monobloc. The SBPC were 2-mm wide and were positioned parallel to one another at a distance of 3 mm. Each set of SBPC had a corresponding measurer, and their length ranged from 20 to 35 mm. In 21 patients (67.7%) the SBPC were implanted in the posterior leaflet and in 10 patients (32.3%) in the anterior leaflet (in 2 patients concurrently in the anterior and posterior leaflets). All patients were assessed by ECO postoperatively, with a 20-month mean follow-up time (range 6-45 months).Results: One patient (3.2%) died of pulmonary embolism during the early postoperative period. Postoperative ECO showed absence of mitral regurgitation in 17 patients (54.8%), mild regurgitation in 9 (29.0%), and mild-to-moderate regurgitation in 4 (12.9%). Opening and mobility of the mitral valve were normal in the 30 surviving patients.Conclusion: The ECO revealed good functionality of the mitral valve apparatus with appropriate leaflet coaptation in patients who had undergone implantation of SBPC for replacement of ruptured or elongated and thinned chordae. A longer follow-up is required to assess absence of calcification and/or degeneration of the SBPC.

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1182 Clinical evidence of the mitral valve leaflet remodeling after st-elevation acute myocardial infarction: longitudinal observation using real-time 3D echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.681 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Nishino ◽

N Watanabe ◽

T Kimura ◽

K Ashikaga ◽

N Kuriyama ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mitral Valve ◽

Clinical Evidence ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Mitral Valve Leaflet ◽

St Elevation ◽

3D Transthoracic Echocardiography

Abstract Background Mitral valve (MV) leaflet remodeling after acute myocardial infarction (AMI) has been proposed as biological and physiological reaction under the ischemic environment mainly by animal experiments. Clinical evidence of leaflet growth after AMI is lacking. Purpose We aimed to assess the clinical evidence of the mitral valve leaflet remodeling after acute myocardial infarction by serial 2D/3D transthoracic echocardiography. Methods Sixty-six patients with first-onset ST-elevation MI (33 anterior and 33 inferior) were serially examined by 2D/3D-transthoracic echocardiography. MV complex geometry including leaflet surface area and leaflet thickness was quantitatively analyzed in acute phase and 6-month follow-up. Results 3D-leaflet surface area was significantly increased in 6-month follow-up (anterior MI; 5.58 [4.93-6.00] versus 5.98 [5.68-6.40] cm²/m²; P < 0.001, inferior MI; 5.48 [4.69-6.07] versus 5.79 [4.74-6.37] cm²/m²; P < 0.001). In anterior MI, both anterior and posterior leaflet lengths significantly increased (anterior leaflet; 12.78 [11.55-13.55] versus 13.63 [12.52-14.15] mm/m²; P = 0.001, posterior leaflet; 9.61 [8.73-10.77] versus 9.84 [8.94-10.96] mm/m²; P = 0.037). In inferior MI, posterior leaflet length significantly increased (9.18 [8.50-10.38] versus 10.00 [8.56-10.85] mm/m²; P = 0.029), while there was no significant change in anterior leaflet length (12.54 [11.61-13.56] versus 12.56 [12.08-14.06] mm/m²; P = 0.214). Leaflet thickness was found to become greater in both groups in 6-month follow-up (anterior MI; 1.08 [0.92-1.21] versus 1.32 [1.25-1.45] mm; P < 0.001, inferior MI; 1.14 [0.98-1.25] versus 1.32 [1.21-1.49] mm; P < 0.001) (Figure). Conclusions In six months from the onset of AMI, MV enlarged in area and increased in thickness. Anterior leaflet mainly enlarged in anterior MI, while posterior leaflet enlarged in inferior MI. This is the first clinical evidence of the MV remodeling after AMI, and long-year follow-up should contribute to assess the course of valve growth with relation to ischemic mitral regurgitation. Abstract 1182 Figure. 3D analysis of the mitral valve

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Correlations between 3D mitral valve parameters and left ventricular remodeling at 6 months after ST elevation myocardial infarction: pilot study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0029 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.I Scarlatescu ◽

S Onciul ◽

A Pascal ◽

D Zamfir ◽

I Petre ◽

...

Keyword(s):

Myocardial Infarction ◽

Mitral Valve ◽

Mitral Annulus ◽

3D Echocardiography ◽

Funding Source ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Lv Remodeling ◽

St Elevation

Abstract Background Mitral valve regurgitation and LV remodeling are associated with worse prognosis in acute ST elevation myocardial infarction (STEMI) patients. 3D echocardiography provides a more accurate assessment of mitral ring and leaflet remodeling thus offering a better understanding of mitral valve (MV) and LV geometrical changes in time. Purpose We aimed to assess the echocardiographic evidence of the mitral valve geometrical changes after STEMI. Methods In this prospective study we included 30 consecutive patients aged between 35 and 68 years old, with STEMI treated by primary PCI. All underwent conventional transthoracic echocardiography. In addition to conventional parameters we measured LV global longitudinal strain (GLS) and mitral valve parameters using 3D echocardiography (4D MV Assessment 2.2 software). All measuremets were performed at baseline and at 6 month follow up. LV remodeling was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) at 6 months after the STEMI. Results We found significant differences in time between LVEF (39.22% vs 43.63%, p=0.00), VTDVS (116ml vs 120ml, p=0.00), LV GLS (−13.41 vs −15.52, p=0.10). LV remodeling at 6 months after STEMI has been observed in 17% of the patients. Regarding the type of the infarction, in anterior STEMI, anterior leaflet surface increased in time (from 6.44cmp vs 7.42cmp, p=0.05), while there was no significant change in posterior leaflet area. In inferior STEMI, the area of posterior mitral leaflet decreased (4.8 cmp vs 4.5 cmp, p=0.52) as well as the leaflet length (1.42 cm vs 1.19 cm p=0.003), but the anterior leaflet remained the same. At 6 months we observed significant differences between the 2 groups (with and without LV remodeling) in the following mitral valve 3D parameters: mitral annulus area (2.6 cmp vs 1.67 cmp, p=0.02), mitral circumference (2.57 cm vs 1.74 cm, p=0.021), bicomisural diameter (2.66 cm vs 2.16 cm, p=0.018), tenting area (p=0.009), anterior leaflet length (2,66 cm vs 2,015 cm p=0.018) and anterior leaflet area (3,69 cmp vs 2.49 cmp, p=0.002). Baseline LV GLS significantly correlated with the following mitral valve 3D parameters at 6 months: anterior leaflet area, posterior leaflet area, anterior leaflet length, tenting height, tenting area, mitral ring 3D area, anteroposterior and bicommissural diameters and mitral circumference (correlation coefficient >0.5). Using linear regression we proved that LV GLS can predict the shortening of the posterior MV (cut off −12.6, AUC 0.844, p=0.011) after 6 months follow up. These findings were independent of the presence and severity of mitral regurgitation. Conclusion Using 3D echocardiography, significant changes in mitral valve geometry were detected at 6 months follow up in STEMI patients. LV remodeling is associated with increased mitral annulus dimensions. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF.

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Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

The Heart Surgery Forum ◽

10.1532/hsf98.20111185 ◽

2012 ◽

Vol 15 (5) ◽

pp. 251

Author(s):

Changqing Gao ◽

Chonglei Ren ◽

Cangsong Xiao ◽

Yang Wu ◽

Gang Wang ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Surgical Procedures ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Septal Myectomy ◽

The Mean

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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Optimizing P2 Neochordal Length and Stability in Mitral Valve Repair With Use of a Polypropylene Loop

Texas Heart Institute Journal ◽

10.14503/thij-18-6913 ◽

2020 ◽

Vol 47 (3) ◽

pp. 207-209

Author(s):

Anil Ozen ◽

Ertekin Utku Unal ◽

Hamdi Mehmet Ozbek ◽

Gorkem Yigit ◽

Hakki Zafer Iscan

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Severe Mitral Regurgitation ◽

Posterior Leaflet ◽

Valve Repair ◽

Chordae Tendineae ◽

Optimal Length ◽

Precise Method ◽

Artificial Chordae

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

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Mitral valve opening in the ovine heart

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.274.2.h552 ◽

1998 ◽

Vol 274 (2) ◽

pp. H552-H563 ◽

Cited By ~ 19

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.

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Functional and Degenerative Mitral Regurgitation: One Ring Fits All?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1696989 ◽

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.

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P1304 Is antibiotic profilaxis really not needed in mitral valve prolapse?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.748 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Suma ◽

S Coli ◽

W Serra ◽

I Spaggiari ◽

A Botti ◽

...

Keyword(s):

Mitral Valve ◽

Antibiotic Therapy ◽

Mitral Valve Prolapse ◽

Valvular Disease ◽

Posterior Leaflet ◽

Class Iii ◽

Level Of Evidence ◽

Native Valve ◽

Dental Procedures

Abstract Patient Presentation A 54 years old woman with dyslipidemia was admitted to the hospital due to the onset of persistent fever. She had no significant comorbidities and she had a known mitral valve prolapse, which was in clinical and echocardiographic follow-up since more than 15 years before. Two months before the hospitalization she underwent dental hygiene procedure without taking any antibiotic before. The procedure included scaling and polishing of the teeth, and she referred just a mild bleeding. After few days she reported the onset of fever and therefore she started to take amoxicilline/clavulanic acid but without any significant improvement of symptoms. Initial work up At the blood chemistry she had a mild leucocytosis with neutrophilia and a rise in inflammatory indices. The Chest x-ray was normal. A systolic murmur was evident at the physical examination. Therefore, Transthoracic Echocardiogram was performed, followed by Transesophageal Echocardiogram (see Figure). At the Echo there was a significant endocarditic involvement of the mitral valve with multiple vegetations, two on the posterior leaflet (scallop P1 and P3) and one on the anterior one (scallop A3); moreover, there was a flail of the posterior leaflet (scallop P1) with subsequent moderate to severe eccentric valve regurgitation. Diagnosis and management Diagnosis of Endocarditis was made and, thus, antibiotic therapy was started with gentamicin and daptomycin, then switched to ampicillin and ceftriaxone after the isolation at the blood culture of Enterococcus Faecalis sensitive to them. Cerebral CT was performed with no evidence of embolization. Finally, owing to the significant endocarditis of the mitral valve with associate moderate to severe regurgitation, the patient underwent surgical intervention with mitral valve replacement with bioprosthesis. Follow-up The post-operative period was regular with no significant complications. She had no more fever and the antibiotics were stopped after six weeks. Conclusion We reported the case of a severe endocarditic involvement of the mitral valve in a patient with known valvular prolapse, who did not take any antibiotic before a minor dental procedure. 2015 ESC guidelines on Endocarditis recommend to not perform antibiotic prophylaxis in patient with no valvular prosthesis but with other form of valvular disease, including mitral valve prolapse (Class III, level of evidence C). Most of the time, patients with other form of valvular disease (e.g. mitral valve prolapse, bicuspid aortic valve, calcific aortic stenosis) do not experience endocarditis, neither after dental procedures. However, this case shows that sometimes it can happen due to the abnormal conformation of the native valve and, hence, it makes us wonder whether the antibiotic therapy should be indicated before dental procedures in those kind of patients. Abstract P1304 Figure.

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On the Interaction of Natural and Mechanical Heart Valve Leaflets With the Chordae Tendineae

Advances in Bioengineering ◽

10.1115/imece2002-32571 ◽

2002 ◽

Author(s):

Amber R. Mace ◽

Pavlos P. Vlachos ◽

Demetri P. Telionis

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mechanical Heart Valve ◽

Postoperative Mortality ◽

Decisive Role ◽

Flow Dynamics ◽

Papillary Muscles ◽

Posterior Leaflet ◽

Chordae Tendineae ◽

Atrioventricular Ring

Long before mitral valve replacement (MVR) became a routine operation, physiologic studies indicated that the continuity of mitral leaflets with papillary muscles, chordae tendineae (CT) and the atrioventricular ring may play a decisive role in the function of the left ventricle (LV) [1]. This led Lillehei et al. [2] to establish a procedure whereby the posterior leaflet, its CT and papillary muscles were preserved in MVRs. These and other studies indicated a significant reduction of postoperative mortality compared to conventional MVR. Though developed in the early 1960s by Lillehei, the technique of chordal preservation was not initially accepted. It wasn’t until 1983 that surgeons began to revive the concept of MVR with preservation of the CT. As this technique became more widely known, many clinical studies were performed; however, very few have been conducted which examine the effect of leaflets and CT on flow dynamics.

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Biaxial Compliance Changes of Mitral Valve Leaflets Following Radiofrequency Ablation

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206761 ◽

2009 ◽

Author(s):

Carolyn G. Norwood ◽

W. David Merryman

Keyword(s):

Blood Flow ◽

Radiofrequency Ablation ◽

Mitral Valve ◽

Left Ventricle ◽

Left Atrium ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Retrograde Blood Flow

The mitral valve (MV), located between the left atrium and left ventricle of the heart, is responsible for preventing retrograde blood flow by closing during systole. There are two MV leaflets, anterior and posterior. The anterior is the larger of the two and semicircular; the posterior leaflet is more rectangular and can be subdivided into three scallops, the middle scallop being the largest in most human hearts. The two leaflets are anchored to the wall of the left ventricle by the chordae tendinae. The MV annulus forms a complete fibrous ring anchored along the anterior leaflet (1).

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Surgical treatment of acute episodes of rheumatic fever

Cardiology in the Young ◽

10.1017/s1047951100000986 ◽

1992 ◽

Vol 2 (3) ◽

pp. 244-246

Author(s):

Pablo Maria Alberto Pomerantzeff ◽

Rachel Snitcowsky ◽

Isabelle Vianna Trevisan ◽

Miguel Barbero Marcial ◽

Geraldo Verginelli ◽

...

Keyword(s):

Surgical Treatment ◽

Mitral Valve ◽

Good Condition ◽

Aortic Insufficiency ◽

Mitral Insufficiency ◽

Inflammatory Condition ◽

History Of ◽

Laboratory Examinations ◽

High Doses

AbstractEight patients, four males and four females, age five to 13 years old (average: 11 years) have undergone surgery in the acute phase of rheumaticfever. The patients presented a history of rheumatic activity characterized by the presence of migratory arthritis and carditis. All patients had severe acute mitral insufficiency, while one of them had associated aortic insufficiency. Laboratory examinations revealed the presence of an acute inflammatory condition. All patients had acute heart failure and were treated initially with high doses of diuretics, peripheral vasopressor and vasodilator amines, together with cardiotonic drugs, without improvement. Surgical treatment was indicated after a period of observation between 24 hours and five days. In five patients, the Doppler echocardiogram revealed rupture and elongation of tendinous cords. Two of them had acute dilatation of the mitral ring, and one had isolated acute dilatation of the mitral ring. Five patients underwent valvar replacement and, in three, valvar repair was carried out. Two patients, who were in cardiogenic shock at the time of their referral, died in the operating room following replacement of the mitral valve. All patients who underwent repair of the mitral valve were in good condition at the last follow-up, six to 27 months after surgery.

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