Mitral valve repair for ischemic mitral insufficiency

Hendren, William G.; Nĕmec, J; Lytle, Bruce W.; Loop, Floyd D.; Taylor, Paul C.; Stewart, Robert W.; Cosgrove, Delos M.

doi:10.1016/0003-4975(91)90008-e

Cited by 109 publications

(47 citation statements)

References 12 publications

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“…[21][22][23] Although the latter group of patients would be categorized as having classic Carpentier type I (normal) leaflet motion, our findings suggest that the MR in these patients may be attributed partially to leaflet tethering, or type IIIb leaflet motion. Because of the intricate geometric relationships from annulus to papillary tips to leaflet edges, we cannot perturb in isolation the annulus, or the papillary tips, without affecting the other structures.…”

Section: Discussionmentioning

confidence: 94%

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Dagum¹,

Timek²,

Green³

et al. 2000

Circulation

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Background-The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results-Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (nϭ7); all others underwent flexible Tailor partial (nϭ5) or Duran complete (nϭ6) ring annuloplasty. After an 8Ϯ2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions-This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

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Section: Discussionmentioning

confidence: 94%

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Dagum¹,

Timek²,

Green³

et al. 2000

Circulation

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“…The remaining patients with IMR have "structural" MR with either papillary muscle rupture or papillary muscle infarction with an intact papillary muscle, each requiring differing surgical repair techniques. 5,19,20 Gillinov et al 5 have demonstrated that papillary muscle rupture portends a superior survival compared with either functional IMR or IMR resulting from papillary muscle infarction. This observation likely reflects preserved left ventricular function and geometry in the setting of papillary muscle rupture, because this clinical scenario tends to present acutely with acute heart failure demanding prompt surgical correction.…”

Section: Pathophysiology Of Imrmentioning

confidence: 99%

Surgical Management of Ischemic Mitral Regurgitation

2009

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“…In our opinion, the anterior part of the closedring prosthesis is not only dispensable but also inconvenient in some situations. The posterior ring annuloplasty concept has been adopted by many surgeons as described by Hendren et al [15], Salvador et al [16] and Salati et al [17] who used bovine pericardium strips fixed by glutaraldehyde. Braile et al [13] who used berets -also made of a bovine pericardium.…”

Section: Discussionmentioning

confidence: 99%

Conservative surgical management of mitral insufficiency: an alternative approach

Gregori¹

2012

Rev Bras Cir Cardiovasc

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Mitral valve insufficiency is frequently the result of elongated or ruptured chordae tendineae. Several techniques have been described for its correction. However, when there is a severe elongation or rupture of the chordae, the most widely accepted treatment option has been valve replacement. The best long-term outcomes observed in conservative surgeries led us to choose this procedure rather than the correction of mitral valve insufficiency. We described three techniques for correction of mitral prolapse due to elongated and/or ruptured chordae tendineae. In addition, we developed mold pre built bovine pericardial chords (Braile-Gregori prosthesis) for chordae replacement. Finally, since 1987, the rigid prosthetic semicircular ring (Gregori-Braile ring) has been consistently used in our centre for correction of the posterior dilation of mitral annulus preferably in its portion close to the posteromedial commissure. Descriptors: Mitral valve/surgery. Mitral valve insufficiency. ResumoA insuficiência mitral é frequentemente resultado do alongamento ou ruptura das cordas tendíneas. Várias técnicas foram descritas para sua correção. Entretanto, quando o comprometimento das cordas é mais intenso, a substituição valvar tem sido mais usualmente empregada. Os bons resultados a longo prazo observados na cirurgia conservadora têm nos levado a eleger esse procedimento como prioridade. Três técnicas foram por nós desenvolvidas para correção de alongamento e/ou ruptura de cordas tendíneas. Além disso, desenvolvemos uma prótese de pericárdio bovino para a substituição de cordas (prótese Braile-Gregori). Finalmente, desde 1987 empregamos o anel rígido semicircular (anel GregoriBraile) para a correção do alongamento posterior do anel mitral, com ênfase na sua porção junto à comissura póstero-medial. Descritores: Valva mitral/cirurgia. Insuficiência da valva mitral.RBCCV

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Mitral valve repair for ischemic mitral insufficiency

Cited by 109 publications

References 12 publications

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Surgical Management of Ischemic Mitral Regurgitation

Conservative surgical management of mitral insufficiency: an alternative approach

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