Differences in mitral valve-left ventricle dimensions between a beating heart and during saline injection test☆

Abstract

The saline injection test could aid in determining the length of the reconstructed chordae. However, the test may provide inaccurate data of the mitral-LV dimensions due to the flattened annulus and overstretched leaflets.

Movement of mitral fibrous components in an isolated porcine working heart model

“…This fact was proved in our previous report in which strut chordae movement was observed with a high-speed camera, and in other reports of animal experiments. 12,13 However, the results of the present study indicate that the strut chordae do not loosen, although they do extend to a slight degree in synchronization with the cardiac cycle. In the normal heart, we found that the contraction ratio of the strut chordae was 2.4%–3.2%, whereas it was 1.8%–2.2% in the deteriorated heart.…”

The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair

“…Besides, in the experimental study of Nonaka et al [8], the distance between the papillary tips and the mitral annular plane remained constant in both SI test and the beating heart respectively. There were, therefore, no significant differences in chords length between the two tests.…”

“…A shortening of the transverse annular diameter reducing the intercommissural width is observed intraoperatively. Moreover, the mitral leaflets appeared to bulge more and the coaptation area appeared wider than on an arrested and flaccid heart [8], offering a physiologically faithful intraoperative evaluation model to real conditions of ventricular load and contractility.…”

“…Perioperative transesophageal echocardiography (TEE) with use of 3D in combination with 2D is essential for successful mitral repair and postoperative monitoring. The saline test (ST) is also an important step and is the most commonly used intraoperative method of mitral valve repair evaluation [8]. However, on the arrested heart and in absence of tension of the subvalvular apparatus, an inefficient and incomplete evaluation is possible.…”

Practice Patterns for the Use of Perioperative Transesophageal Echocardiography: A Practice not yet Made Perfect

“…15 However, because of the annular conformational differences in the arrested and beating heart, discrepancies between direct surgical and intraoperative TEE assessment of valve competency can occur. 17 Surgical resistance to relinquish the immense responsibility of testing valve integrity over to another provider is understandable, particularly considering that in one survey, only 63% of cardiac anesthesiologists had passed the National Board of Echocardiography advanced examination. 11 Of considerable controversy in the MacKay et al study is the trend toward less perioperative TEE use in patients undergoing cardiac valve surgery who were identified as Hispanic.…”