Comparison of the Carpentier and Duran prosthetic rings used in mitral reconstruction

Chen

Circ: Cardiovascular Imaging

et al. 2013

Background-We have observed that elevated mitral gradients can develop in some patients after mitral valve repair for degenerative mitral regurgitation. Methods and Results-We screened 275 patients who had mitral valve repair involving >1 leaflet scallop between October 2001 and July 2010. Mitral valve hemodynamics were assessed at rest and at peak exercise using the cycle ergometer. B-type natriuretic peptide levels were measured at rest and after exercise. The patients also performed a 6-minute walk test and short-form 36-Item Health Survey questionnaire. We enrolled 110 patients, with resting mean mitral diastolic gradient of ≤3 mm Hg in 35 patients (group 1) and >3 mm Hg indicative of elevated mitral gradients in 75 patients (group 2). Posterior mitral leaflet plication (P=0.04) and the use of a complete mitral annuloplasty ring (P<0.0001) were associated with elevated mitral gradients. Group 2 patients had larger left atrial volume (P=0.02), higher mitral gradients at peak exercise and higher pulmonary artery systolic pressure at rest and at peak exercise, and lower exercise capacity (101±40 versus 122±51 W; P=0.02). Group 2 patients also had higher B-type natriuretic peptide levels and lower scores in 3 short-form 36-Item Health Survey health concepts. Multivariate regression analyses showed that mitral valve area was an independent predictor of maximum exercise capacity (P=0.003). Conclusions-After mitral valve repair for degenerative mitral regurgitation, elevated mitral gradients is not uncommon and is associated with worse intracardiac hemodynamics, higher B-type natriuretic peptide levels, lower exercise capacity, and poorer quality of life. Further refinement in the surgical technique may reduce the incidence of this complication. (Circ Cardiovasc Imaging. 2013;6:1041-1047.)Key Words: exercise capacity ◼ mitral valve insufficiency ◼ mitral valve repair ◼ mitral valve stenosis ◼ quality of life

Section: Implications For MV Repairmentioning

confidence: 99%

Functional Significance of Elevated Mitral Gradients After Repair for Degenerative Mitral Regurgitation

Chen

Circ: Cardiovascular Imaging

et al. 2013

Rev Bras Cir Cardiovasc

“…Recentemente, vários autores (19,27) têm demonstrado desvantagens com o uso do anel rígido, incluindo deformação da geometria natural do anel e possível obstrução da via de saída do VE. Conseqüentemente, diferentes propostas surgem para os vários tipos de técnicas de remodelamento, baseadas na redução ou reforço apenas da porção posterior do anel.…”

Section: Considerações Finaisunclassified

Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada

Hueb¹,

Jatene²,

Moreira³

et al. 2001

P M A, Mioto B M, Chabelmann R C, Oliveira S A -Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada. Material e Métodos: Analisaram-se 68 corações humanos adultos, fixados, sendo 48 portadores de CMD de etiologia isquêmica ou idiopática, e 20 corações sem cardiopatia. Obteve-se imagens digitalizadas do perímetro do anel mitral, inserção da cúspide anterior e posterior e da porção fibrosa e muscular. Obteve-se também o perímetro interno do VE, distância do septo ao músculo papilar anterior e posterior, distância entre os músculos papilares, e extensão do septo interventricular.Resultados: A análise dos resultados demonstrou proporcionalidade, tanto da porção fibrosa (r 2 = 0.98), quanto da porção muscular (r 2 = 0.99) do anel em relação ao grau de dilatação da valva mitral. A regressão linear revelou que o perímetro de inserção das cúspides anterior (r 2 = 0.96) e posterior (r 2 =0.98) também guardam relação de proporcionalidade. Observou-se que a dilatação do VE ocorre de forma global e esférica em seus segmentos. Não se observou relação de proporcionalidade entre o grau de dilatação do anel mitral e do VE.Conclusão: Ao contrário do que se pensava, na CMD de etiologia isquêmica ou idiopática, a dilatação do anel mitral ocorre de forma proporcional e não apenas na sua porção posterior. Não é o grau de dilatação do VE que determina o grau de dilatação do anel mitral pois eles ocorrem de forma independente. Estas observações abrem novas perspectivas para as técnicas de correção da insuficiência valvar mitral na CMD.

“…11,34 In recent years a large amount of interest has been shown in the development of annuloplasty techniques by percutaneous path (which would not require open surgery or connection to an extracorporeal circulation pump), some of the paths being based on the anatomical proximity between the coronary sinus and the mitral valve ring. There are already various devices being developed that are inserted by venous path (jugular or femoral) and are placed in the coronary sinus, and which after the application of traction, retraction or heat reduce their perimeter, achieving a reduction in the mitral ring and the degree of insufficiency (Fig.…”

Section: The Problem Of Mitral Insufficiencymentioning

confidence: 99%

“…[10][11][12]14,21,34,41,43 Rigid monoplane prostheses have been displaced due to the large number of experimental and clinical works showing that the perimeter of the mitral ring constantly changes size and shape during the cardiac cycle. Recent findings that these changes are produced in a three-dimensional way with an approximately hyperbolic paraboloid shape, have given rise to new rigid three-dimensional prostheses.…”

Section: The Problem Of Mitral Insufficiencymentioning

confidence: 99%

Development of Personalized Annuloplasty Rings: Combination of CT Images and CAD-CAM Tools

et al. 2009

Although the use of personalized annuloplasty rings manufactured for each patient according to the size and morphology of their valve complex could be beneficial for the treatment of mitral insufficiency, this possibility has been limited for reasons of time-lines and costs as well as for design and manufacturing difficulties, as has been the case with other personalized implant and prosthetic developments. However, the present quality of medical image capture equipment together with the benefits to be had from computer-aided design and manufacturing technologies (CAD-CAM) and the capabilities furnished by rapid prototyping technologies, present new opportunities for a personalized response to the development of implants and prostheses, the social impact of which could turn out to be highly positive. This paper sets out a personalized development of an annuloplasty ring based on the combined use of information from medical imaging, from CAD-CAM design programs and prototype manufacture using rapid prototyping technologies.