scholarly journals Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection

2022 ◽  
Vol 8 ◽  
Author(s):  
Johannes H. Jedrzejczyk ◽  
Lisa Carlson Hanse ◽  
Shadi Javadian ◽  
Søren N. Skov ◽  
J. Michael Hasenkam ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Type I ◽  
Search Term ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Annular Dilatation ◽  
Specific Morphology ◽  
Leaflet Coaptation ◽  
Flexible Ring

Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term “mitral valve annuloplasty,” a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.

scholarly journals Adult Obstructive Cor Triatriatum with Severe Mitral Regurgitation: A Case Report

2021 ◽  
Vol 24 (3) ◽  
pp. E578-E579
Author(s):  
Tomomi Nakajima ◽  
Dung Van Hung ◽  
Yuji Hiramatsu
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Cor Triatriatum ◽  
Severe Mitral Regurgitation ◽  
Mitral Annuloplasty ◽  
Progressive Heart Failure ◽  
Left Ventricular Dilatation ◽  
Annular Dilatation ◽  
Cor Triatriatum Sinister

Adult cor triatriatum sinister associated with severe mitral regurgitation is extremely rare. As these obstructive cor triatriatum feature hemodynamics that mimic mitral stenosis, a pressure load is theoretically generated only on the left atrial proximal chamber, and therefore the left ventricle is less likely to suffer volume loading. Here, we report a surgical case with such rare hemodynamics. A 22-year-old man with obstructive cor triatriatum and severe mitral regurgitation received an anomalous membrane excision and mitral annuloplasty. An abnormal membrane with an orifice 7 mm in size was completely resected while a grossly dilated mitral annulus was repaired via annuloplasty ring. Mitral regurgitation was controlled well, and the postoperative course was uneventful. Even with obstructive cor triatriatum, severe mitral annular dilatation and subsequent left ventricular dilatation may occur, causing the progressive heart failure encountered in this case.

Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation

2009 ◽  
Vol 5 (1) ◽  
pp. 67
Author(s):  
Lutz Buellesfeld ◽  
Lazar Mandinov ◽  
Eberhard Grube ◽  
◽  
◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Standard Of Care ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Invasive Treatment ◽  
Large Variability ◽  
Mitral Annuloplasty ◽  
Number Of Patients ◽  
Anatomical Relationship

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

scholarly journals Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation—a case report

2021 ◽  
Author(s):  
Harish Sharma ◽  
Adnan Nadir ◽  
Richard P Steeds ◽  
Sagar N Doshi
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Severe Mitral Regurgitation ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Case Summary ◽  
Valve Implantation ◽  
Two Jets

Abstract Background Annuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation. Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring transcatheter mitral valve implantation has been described to treat trans-ring or para-ring jets but not both concurrently. Case summary A 78-year-old male presented with severe mitral regurgitation due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transesophageal echocardiography showed two jets of regurgitation; trans-ring and para- ring. Repair was successfully undertaken with a valve-in-ring procedure (29 mm S3 Edwards Lifesciences). Discussion Patients with failure of mitral valve annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by valve-in-ring transcatheter mitral valve implantation.

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 New Mitral Annuloplasty Ring Enables Oversizing of Transcatheter Heart Valve and Prevents Central or Paravalvular Leakage

2017 ◽  
Vol 65 (06) ◽  
pp. 460-466
Author(s):  
Jan-Malte Sinning ◽  
Armin Welz ◽  
Fritz Mellert ◽  
Georg Duerr
Keyword(s):  
Mitral Regurgitation ◽  
Heart Valve ◽  
Proof Of Concept ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Concept Study ◽  
Paravalvular Leakage ◽  
Potential Source ◽  
Transcatheter Heart Valve ◽  
Transcatheter Valve

Background Transcatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue. Methods A rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes. Results Fluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from “oval” to “round” and anchored the THV leaving no paravalvular or central gaps as potential source for PVL. Conclusion We developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.

scholarly journals Epicardial Posterior Papillary Muscle Repositioning with Mitral Annular Reduction for FIMR Treatment: Initial Ex Vivo Heart Model Study

2020 ◽  
Vol 23 (1) ◽  
pp. E010-E017
Author(s):  
Krishaporn Kradangnga ◽  
Eric Monnet
Keyword(s):  
Mitral Regurgitation ◽  
Ex Vivo ◽  
Frontal Plane ◽  
Left Ventricular ◽  
Percentage Increase ◽  
Percentage Decrease ◽  
Model Study ◽  
Annular Dilatation ◽  
Α Angle ◽  
Leaflet Coaptation

Background: High recurrent functional ischemic mitral regurgitation (FIMR) has been observed after annuloplasty. Since annuloplasty alone could not prevent late recurrent FIMR or improve the survival rate after CABG, adjunctive subvalvular opt for better treatment tailored for each individual patient. Methods: Ex vivo ovine heart models with annular dilatation and PPM displacement were used for analysis of mitral regurgitation (MR) flow, left ventricular and annular geometry after treatment by mitral annular reduction alone (MA, nMA = 12) or combined with epicardial PPM repositioning (MA+PPM, nMA+PPM=13). Results: MR significantly was reduced from baseline in both the MA (P = .03) and MA+PPM (P = .02) groups, but was not significantly different between the groups. The septo-lateral mitral annular distance decreased after applying both methods (MA group P = .005; MA+PPM group P = .05). The tethering α angle of the APM in the frontal plane significantly increased from baseline in the MA+PPM group (P = .027). Furthermore, the MA+PPM group had a larger APM and PPM α angle in the frontal plane compared with the MA group after reducing the MR (P = .04). There were no statistically significant changes in tethering angles found in the MA group compared with baseline. MR reduction correlated with percentage decrease of septo-lateral mitral annular distance (rs = 0.51, P = .01), the percentage decrease of fibrosa-PPM distance (rs = 0.43, P = .03), and the percentage increase of the PPM anterior displacement (rs = -0.41, P = .04). Conclusion: The decreased tethered angle of the PPM referred to the annulus, and the decreased interpapillary muscles distance suggested the PPM was repositioned inward and toward the septal annulus by the epicardial pushing pad. Epicardial repositioning of the PPM adjunct with mitral annular reduction facilitated leaflet coaptation without the risk of overlying restriction of the mitral annular orifice.

scholarly journals Early Period Mitral Stenosis After Mitral Annuloplasty: Functional or Real Stenosis?

2021 ◽  
Author(s):  
Serkan Asil ◽  
Veysel Özgür Barış ◽  
Suat Görmel ◽  
Murat Çelik ◽  
Uygar Çağdaş Yüksel
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Stenosis ◽  
Early Period ◽  
Valve Repair ◽  
Mitral Valve Leaflet ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty

Abstract Background:Surgical repair of rheumatic mitral valve disease is technically more demanding however, mitral repair is preferred over mechanical valve implantation if possible. İn this case report we presented the case of functional mitral stenosis after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. Case Report:A 64-year-old female patient was admitted to our clinic with progressively worsening shortness of breath (New York Heart Association-Classification II-III), 6 months after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. The 28/13 mmHg gradient was observed in the mitral valve annuloplasty ring in transthoracic echocardiography. TEE findings showed that motions of the mitral valve leaflet were fine, but in the mitral annuloplasty ring there was an extreme constriction and increased gradient.Conclusion:The development of mitral stenosis following mitral valve surgery is a condition associated with multiple mechanisms that are poorly understood. Mitral valve repair can be difficult and low success rate, especially in rheumatic mitral valve patients. The defect in the surgical technique and the application of restrictive small annuloplasty causes an increased gradient, leading to the development of severe functional mitral stenosis, especially when accompanied by a slight increase in pannus tissue.

Modeling the Interaction Between the Coronary Sinus and the Proximal Anchor Stent in Percutaneous Transvenous Mitral Annuloplasty

2010 ◽  
Author(s):  
Wei Sun ◽  
Milton DeHerrera
Keyword(s):  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Computational Tools ◽  
Mitral Annuloplasty ◽  
Quantitative Understanding ◽  
Valve Annulus ◽  
Implanted Device ◽  
Anterior Posterior

Surgical treatment of severe functional mitral regurgitation (MR) often involves mitral annuloplasty, a procedure where a flexible or rigid annuloplasty ring is used to downsize the dilated mitral valve annulus (MA) and improve leaflet apposition by posterior annular correction. Recently various minimally invasive percutaneous transvenous mitral annuloplasty (PTMA) devices have been tested in patients who are not suitable candidates for a surgical procedure involving a thoracotomy. The approach is based on the concept that by utilizing the parallel location of the coronary sinus (CS) to the mitral annulus, a device, that can reshape the annulus, can be percutaneously deployed within the coronary sinus (CS) and the great cardiac vein (GCV). When the implanted device deforms, it shortens the MA anterior-posterior dimension and decreases mitral regurgitation (MR) (Fig. 1). Although the approach has been shown to be promising, PTMA device dysfunction and fatigue fracture have been reported in several firstin-human clinical trials (1). We hypothesize that quantitative understanding of the biomechanical interaction between the venous tissue, the mitral improve the efficacy of the PTMA treatment of MR. In this study, we aim to model interactions between the PTMA proximal anchor and the CS using computational tools.

Mitral Annular Dilatation and Papillary Muscle Dislocation Without Mitral Regurgitation in Sheep

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
G. Randall Green ◽  
Paul Dagum ◽  
Julie R. Glasson ◽  
George T. Daughters ◽  
Ann F. Bolger ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ex Vivo ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
3 Dimensional ◽  
Annular Dilatation ◽  
Muscle Geometry ◽  
Anterior Papillary Muscle

Background —Asymmetrical mitral annular (MA) dilatation and papillary muscle dislocation are implicated in the pathogenesis of functional mitral regurgitation (MR). Methods and Results —To determine the mechanism by which annular and papillary muscle geometric alterations result in MR, we implanted radiopaque markers in the left ventricle, mitral annulus, anterior and posterior mitral leaflets, and papillary muscle tips and bases in 2 groups of sheep. One group served as controls (CTL, n=7); an experimental group (EXP, n=9) underwent topical phenol application to obliterate anterior annular and leaflet muscle (confirmed histologically ex vivo). After 1 week of recovery, markers were imaged with biplane videofluoroscopy, and hemodynamic data were recorded. MA area (computed from 3-dimensional marker coordinates) was 11% to 13% larger in the EXP group than in the CTL group ( P <0.05 by ANOVA). This area increase resulted exclusively from intercommissural axis increase except in 1 heart with large (>1 cm) increases in both the intercommissural and septolateral annular axes. The anterior papillary muscle tip in EXP was displaced from CTL by 2.9±0.23 mm toward the anterolateral left ventricle and 2.5±0.12 mm toward the mitral annulus at end systole; the posterior papillary muscle geometry was unchanged. Transthoracic echocardiography revealed MR only in the heart exhibiting biaxial annular enlargement. Conclusions —MA dilatation in the intercommissural dimension with anterior papillary muscle tip displacement toward the annulus is insufficient to produce MR in sheep. Functional MR may require MA dilatation in the septolateral axis, as observed with proximal circumflex coronary occlusion.

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