Proporção entre os segmentos do anel da valva tricúspide normal: um parâmetro para realização da anuloplastia valvar

Abstract

Proporção entre os segmentos do anel da valva tricúspide normal: um parâmetro para realização da anuloplastia valvarProportion among the segments of the normal tricuspid valve annulus: parameter for valve annuloplasty

New contribution to the tudy of ventricular remodeling and valve rings in dilated cardiomyopathy: anatomical and histological evaluation

“…Although often seen as secondary only to ventricular remodeling and it is therefore classified as "functional", recent studies indicate that possibly there are intrinsic components to the valve structure as a whole that acting differently can be responsible for the observed failure [ 4 , 6 ] . The valve leaflets, although considered to be only inert, because apparently they are not committed in cases of idDCM, contrary to what happens in other types of valvular regurgitation, present their own characteristics that must be taken into account, such as afferent and efferent innervation, intrinsic contractile properties, and spatial orientation of collagenous fibers that allows optimal distribution of mechanical stress, so that the remodeling of the leaflets possibly plays an intrinsic role in the genesis of valve failure, as demonstrated by Timek et al [ 4 ] in experimental study in sheep. This fact comes against the results observed in our study, since there was no statistically significant dilation of the LVR, which seems to confirm the fact that it is not only the possible expansion of the ring that causes failure.…”

“…Ventricular remodeling characterized by both right and left morphogeometrical changes, provides vicious cycle of functional deterioration, since the heart loses its original anatomical conformation, which is critical to its efficiency. In this context, the valve insufficiency caused primarily by expansion of the atrioventricular rings is of paramount importance [ 1 ] , but despite this relevant fact, the rings expansion mechanism is not completely understood [ 2 - 4 ] .…”

Plastia tricúspide utilizando anuloplastia baseada na proporção entre os segmentos do anel da valva tricúspide normal

“…research in our group. In this way, the first stage of the present study was carried out as a part of the data found in a previous study [14], which defined the proportion to be used in the tricuspid annuloplasty as 2.43:1.…”

“…They have studied hearts without formalinfixation immersion [13,14]. Searching for a more closely stage to the physiologic status, the study measures developed by our group were carried out in hearts with RV distention and continent tricuspid valve [14]. The proportion found between both anteroposterior and septal segments in hearts with normal tricuspid valve was 2.43:1.…”

“…Two studies regarding tricuspid valve anatomy have recently been publish reporting the proportions between normal tricuspid ring segments [13,14]. Both studies suggest using these measurements as parameters for tricuspid valve annuloplasty.…”