scholarly journals Effect of Edge-to-Edge Mitral Valve Repair on Chordal Strain: Fluid-Structure Interaction Simulations

Biology ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. 173 ◽  
Author(s):  
Milan Toma ◽  
Daniel R. Einstein ◽  
Keshav Kohli ◽  
Sheridan L. Caroll ◽  
Charles H. Bloodworth ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Fold Increase ◽  
Mitral Valve Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Papillary Muscles ◽  
Risk Patients ◽  
Procedural Complications ◽  
Regurgitant Orifice Area ◽  
Normal Mitral Valve

Edge-to-edge repair for mitral valve regurgitation is being increasingly performed in high-surgical risk patients using minimally invasive mitral clipping devices. Known procedural complications include chordal rupture and mitral leaflet perforation. Hence, it is important to quantitatively evaluate the effect of edge-to-edge repair on chordal integrity. in this study, we employ a computational mitral valve model to simulate functional mitral regurgitation (FMR) by creating papillary muscle displacement. Edge-to-edge repair is then modeled by simulated coaptation of the mid portion of the mitral leaflets. in the setting of simulated FMR, edge-to-edge repair was shown to sustain low regurgitant orifice area, until a two fold increase in the inter-papillary muscle distance as compared to the normal mitral valve. Strain in the chordae was evaluated near the papillary muscles and the leaflets. Following edge-to-edge repair, strain near the papillary muscles did not significantly change relative to the unrepaired valve, while strain near the leaflets increased significantly relative to the unrepaired valve. These data demonstrate the potential for computational simulations to aid in the pre-procedural evaluation of possible complications such as chordal rupture and leaflet perforation following percutaneous edge-to-edge repair.

Papillary Muscle Sandwich Plasty for the Treatment of Functional Mitral Valve Regurgitation

2011 ◽  
Vol 96 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Susumu Ishikawa ◽  
Keisuke Ueda ◽  
Kazuo Neya ◽  
Akio Kawasaki ◽  
Akihito Kakinuma ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Papillary Muscle ◽  
Aortic Valve Disease ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Regurgitation ◽  
Left Ventricular Dilatation

Abstract We evaluated the availability of original “sandwich plasty” for the treatment of functional mitral regurgitation (FMR) associated with ischemic heart disease (IHD) and aortic valve disease (AVD). Forty-three patients were reviewed, including 27 IHD patients and 16 AVD patients. Preoperatively severe FMR was detected in 14 patients, moderate FMR in 26, and mild FMR in 3. The papillary muscle heads of anterior leaflets and posterior leaflets were approximated using Teflon-pledgeted 3-0 Ticron sutures at anterolateral and posteromedial commissural portions. After surgery, residual moderate FMR was observed in 1 patient and mild FMR in 3 patients. Tenting height of the mitral valve significantly decreased. FMR free rates 2 years after surgery were 93% among IHD patients and 83% in AVD patients. “Sandwich plasty” was simple and effective for the treatment of functional FMR caused by tethering effects due to left ventricular dilatation.

Minimally Invasive Mitral Valve Annuloplasty with Realignment of Both Papillary Muscles for Correction of Type IIIb Functional Mitral Regurgitation

2017 ◽  
Vol 12 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Evaldas Girdauskas ◽  
Lenard Conradi ◽  
Eva Karolina Harmel ◽  
Hermann Reichenspurner
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Papillary Muscle ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
High Recurrence Rate ◽  
Papillary Muscles ◽  
Type Iiib

Objective Pathophysiological background of type IIIb functional mitral regurgitation (FMR) is a progressively increasing distance between papillary muscle tips and mitral annular plane. Standard surgical treatment of such FMR by means of undersized mitral annuloplasty is associated with a high recurrence rate. Methods We propose a modified subannular maneuver to correct type IIIb FMR while combining undersized annuloplasty with a controlled realignment of both papillary muscles, thereby fixing the distance between mitral annular plane and papillary muscle tips. The differences of this subannular maneuver as compared with the previously published techniques are the following: (1) controlled realignment of both papillary muscles, (2) fixation of the papillary muscles to mitral annulus distance on an annuloplasty ring, and (3) application in a three-dimensional endoscopic minithoracotomy setting. Results We describe a surgical technique of minimally invasive mitral valve repair performed due to severe type IIIb FMR, which includes a modified subannular maneuver to realign both papillary muscles. Preliminary results of the first 10 patients who underwent this procedure at our institution are presented. There was no in-hospital mortality and follow-up echocardiography (mean ± SD echocardiographic follow-up = 10 ± 6 months) demonstrated stable functional results. Conclusions Our initial experience indicates that adding of this subannular maneuver to the standard annuloplasty and thereby fixing the distance between papillary muscles and mitral annular plane have a potential to improve results of surgical FMR treatment.

scholarly journals Cephalad misplacement of a pulmonary artery catheter in a patient with a preexisting Hickman catheter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hoon Choi ◽  
Joon Pyo Jeon ◽  
Jaewon Huh ◽  
Youme Kim ◽  
Wonjung Hwang
Keyword(s):  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Case Reports ◽  
Mitral Valve Regurgitation ◽  
Catheter Insertion ◽  
Routine Practice ◽  
Hickman Catheter ◽  
Risk Patients ◽  
The Right

Abstract Background Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date. Case presentation An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications. Conclusions To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.

Papillary Muscle Heads Focalization for Functional Mitral Valve Regurgitation

2020 ◽  
Vol 110 (1) ◽  
pp. e59-e61
Author(s):  
Masatoshi Hata ◽  
Buntaro Fujita ◽  
Kavous Hakim-Meibodi ◽  
Jan F. Gummert
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Functional Mitral Valve Regurgitation

Coaptation Mechanism of Dilated Mitral Valves

2010 ◽  
Author(s):  
Bo Gao ◽  
Zhaoming He
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Common Complication ◽  
Mitral Valves ◽  
Global Left Ventricular ◽  
Normal Mitral Valve

Functional mitral regurgitation, which occurs as a consequence of regional of global left ventricular or global left ventricular dysfunction despite structurally normal mitral valve (MV), is a common complication in patients with ischemic or non-ischemic cardiomyopathies [1].

Echocardiography of congenital mitral valve disorders: echocardiographic–morphological comparisons

2014 ◽  
Vol 24 (6) ◽  
pp. 1030-1048 ◽  
Author(s):  
Norman H. Silverman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Stenosis ◽  
Congenital Abnormalities ◽  
High Morbidity ◽  
Papillary Muscles ◽  
Anatomical Correlation ◽  
Mitral Prolapse ◽  
Autopsy Specimens ◽  
Double Orifice

AbstractI surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

Relocation of Papillary Muscles for Ischemic Mitral Valve Regurgitation

2014 ◽  
Vol 9 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Khalil Fattouch ◽  
Sebastiano Castrovinci ◽  
Giacomo Murana ◽  
Pietro Dioguardi ◽  
Francesco Guccione ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Geometric Model ◽  
Three Dimensional ◽  
Mitral Valve Regurgitation ◽  
Papillary Muscles ◽  
Valve Repair ◽  
Truncated Cone ◽  
Significant Difference ◽  
The Mean

Objective The assessment of the mitral valve apparatus (MVA) and its modifications during ischemic mitral regurgitation (IMR) is better performed by three-dimensional (3D) transesophageal echocardiography (TEE). The aim of our study was to carry out nonrestrictive mitral annuloplasty in addition to relocation of papillary muscles (PPMs) oriented by preoperative real-time 3D TEE through the mitral valve quantification dedicated software. Methods Since January 2008, a total of 70 patients with severe IMR were examined both before and after mitral valve repair. The mean (SD) coaptation depth and the mean (SD) tenting area were 1.4 (0.4) cm and 3.2 (0.5) cm2, respectively. Intraoperative 3D TEE was performed, followed by a 3D offline reconstruction of the MVA. A schematic MVA model was obtained, and a geometric model as a “truncated cone” was traced according to preoperative data. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth of approximately 6 mm was used to detect the new position of the PPMs tips. Results Perioperative offline reconstruction of the MVA and the respective truncated cone was feasible in all patients. The expected position of the PPMs tips, desirable to reach a normal tenting area with a coaptation depth of 6 mm or more, was obtained in all patients. After surgery, all parameters were calculated, and no statistically significant difference was found compared with the expected data. Conclusions Relocation of PPMs plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results in patients with severe IMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.

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