Evaluation of the Mitral Valve Leaflet Morphology After Mitral Valve Reconstruction with a Concept "Coaptation Length Index"

Abstract

Background: In clinical settings, information on morphology of mitral valve leaflet after mitral valve reconstruction is limited. Methods: Between January 1996 and June 2000, 36 underwent mitral valve repair for mitral regurgitation (MR). The etiology of mitral insufficiency was prolapse, dilated annulus, and ischemic. Ring annuloplasty was performed in all cases. Mitral valve short-axis dimension (MVd), vertical distance between annular line and closing point (Vd), coaptation length (CL), coaptation length index (CL/MVd) were measured by the two-dimensional transesophageal echocardiography for the present 11 cases. Results: In 11 cases, residual MR, using a scale from 0 to 4, was 0 in 5 patients, 1 in 4 patients, 2 in 2 patients whose etiology of regurgitation was cardiomyopathy. MVd and Vd decreased significantly (38.7 ± 6.2 to 27.0 ± 5.6 mm, 10.1 ± 7.7 to 6.5 ± 4.6 mm, respectively). CL and CLI increased significantly (6.4 ± 2.4 to 11.6 ± 4.6 mm, 0.16 ± 0.06 to 0.44 ± 0.21, respectively). Among those index, only CLI have a statistically significant negative correlation with the degree of residual MR. Conclusion: The mitral valve ring annuloplasty produce the morphologic change of mitral apparatus, especially the increase of CLI, which may be one of the main factors in regulation of regurgitation

Saddle-Shape Annuloplasty Increases Mitral Leaflet Coaptation After Repair for Flail Posterior Leaflet

“…The standard evaluation of leaflet coaptation provided by 2D echocardiography is a one-dimensional coaptation length usually obtained as close to the valve center as possible. [19,20] Figure 5 demonstrates that the saddle-shaped ring influences coaptation length least in the middle of the valve. As a result 2D echocardiographic imaging directed at this region would have drastically under estimated the influence of ring shape on leaflet coaptation.…”

Dynamic Simulation of Bioprosthetic Heart Valves Using a Stress Resultant Shell Model

“…16,17,42 In this study, we present the basic concept and algorithm of our fully experiment-based shell element model (FEBSEM). Since leaflet coaptation is an important index of stresses on the leaflet which may be closely related with valvular heart diseases, 23,48 a contact element formulation is introduced to the FEBSEM to extend the dynamic analysis of BHV function to the closing phase of the cardiac cycle. Additionally, damping effect on the leaflet due to the surrounding blood is incorporated for a more accurate and realistic dynamic simulation using a physiologically measured damping constant.…”

Surgical Approach to Mitral Regurgitation in Chronic Heart Failure: When Is It an Option?

“…Multiple preoperative echocardiographic factors identify patients at high likelihood of MR recurrence after annuloplasty (Table 2) [43][44][45][46]. They reflect severely dilated and remodeled ventricles with a spherical shape (large systolic and diastolic dimensions, volumes, interpapillary muscle distance, and increased sphericity index) [39••, [43][44][45][46][47][48] that led to severe leaflet tethering reflected on large tenting areas, tenting heights, and leaflet angles [3, 4••, 13, 49•, [50][51][52][53][54]. A central regurgitant jet and complex jets are also a reflection of symmetric tethering and advanced remodeling [23].…”