Recurrent Mitral Regurgitation Late after Annuloplasty for Ischemic Mitral Regurgitation

Shiota, Benjiro; Gillinov, A. Marc; Takasaki, Kunitsugu; Fukuda, Shota; Shiota, Takahiro

doi:10.1111/j.1540-8175.2010.01284.x

Cited by 23 publications

(12 citation statements)

References 29 publications

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“…Despite successful mitral repair with annuloplasty ring implantation, recurrent mitral regurgitation may occur in about 5–10% of patients with organic mitral valve disease [15] and upwards of 30% or more of patients with functional/ischemic mitral regurgitation [16, 17]. A potential, device-related cause for recurrent mitral valve regurgitation includes ring dehiscence [18–20].…”

Section: Discussionmentioning

confidence: 99%

How Do Annuloplasty Rings Affect Mitral Annular Strains in the Normal Beating Ovine Heart?

et al. 2012

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Background We hypothesized that annuloplasty ring implantation alters mitral annular strains in a normal beating ovine heart preparation. Methods and Results Sheep had 16 radiopaque markers sewn equally spaced around the mitral annulus. Edwards Cosgrove partial flexible band (COS, n=12), St. Jude complete rigid saddle-shaped annuloplasty ring (RSA, n=10), Carpentier-Edwards Physio (PHY, n=11), IMR ETlogix (ETL, n=11), and GeoForm (GEO, n=12) annuloplasty rings were implanted in a releasable fashion. Four-dimensional marker coordinates were obtained using biplane videofluoroscopy with the ring inserted (Ring) and after ring release (Control). From marker coordinates, a functional spatio-temporal representation of each annulus was generated through a best fit using 16 piecewise cubic Hermitian splines. Absolute total mitral annular strains were calculated from the relative change in length of the tangent vector to the annular curve as strains occurring from Control to Ring state at end-systole. In addition, average Green-Lagrange strains occurring from Control to Ring state at end-systole along the annulus were calculated. Absolute total mitral annular ring strains were smallest for COS and greatest for ETL. Strains for RSA, PHY and GEO were similar. Except for COS in the septal mitral annular segment, all rings induced compressive strains along the entire annulus with greatest values occurring at the lateral mitral annular segment. Conclusions In healthy, beating ovine hearts, annuloplasty rings (COS; RSA, PHY, ETL and GEO) induce compressive strains that are: 1.) Predominate in the lateral annular region; 2.) Smallest for flexible partial bands (COS) and greatest for an asymmetric rigid ring type with intrinsic septal-lateral downsizing (ETL). However, the ring type with the most drastic intrinsic septal-lateral downsizing (GEO) introduced strains similar to physiologically shaped rings (RSA and PHY) indicating that rings effects on annular strain profiles cannot be estimated from the degree of septal-lateral downsizing.

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Section: Discussionmentioning

confidence: 99%

How Do Annuloplasty Rings Affect Mitral Annular Strains in the Normal Beating Ovine Heart?

et al. 2012

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“…1-5 Restrictive annuloplasty, combined with coronary revascularization, is currently the most commonly performed surgical procedure to treat chronic IMR. However, the variable results, 6-8 the potentially induced mitral stenosis, 9 and the high rate of mitral regurgitation (MR) recurrence after this strategy suggest the need for a new approach that addresses the subvalvular mitral valve apparatus.…”

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confidence: 99%

Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling

et al. 2012

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Background Undersized ring annuloplasty for ischemic mitral regurgitation (MR) is associated with variable results and >30% MR recurrence. We tested whether subvalvular repair by severing second-order mitral chordae can improve annuloplasty by reducing papillary muscle tethering. Methods and Results Posterolateral myocardial infarction known to produce chronic remodeling and MR was created in 28 sheep. At 3 months, sheep were randomized to sham surgery versus isolated undersized annuloplasty versus isolated bileaflet chordal cutting versus the combined therapy (n=7 each). At baseline, chronic myocardial infarction (3 months), and euthanasia (6.6 months), we measured left ventricular (LV) volumes and ejection fraction, wall motion score index, MR regurgitation fraction and vena contracta, mitral annulus area, and posterior leaflet restriction angle (posterior leaflet to mitral annulus area) by 2-dimensional and 3-dimensional echocardiography. All groups were comparable at baseline and chronic myocardial infarction, with mild to moderate MR (MR vena contracta, 4.6±0.1 mm; MR regurgitation fraction, 24.2±2.9%) and mitral annulus dilatation (P<0.01). At euthanasia, MR progressed to moderate to severe in controls but decreased to trace with ring plus chordal cutting versus trace to mild with chordal cutting alone versus mild to moderate with ring alone (MR vena contracta, 5.9±1.1 mm in controls, 0.5±0.08 with both, 1.0±0.9 with chordal cutting alone, 2.0±0.7 with ring alone; P<0.01). In addition, LV end-systolic volume increased by 108% in controls versus 28% with ring plus chordal cutting, less than with each intervention alone (P<0.01). In multivariate analysis, LV end-systolic volume and mitral annulus area most strongly predicted MR (r2=0.82, P<0.01). Conclusions Comprehensive annular and subvalvular repair improves long-term reduction of both chronic ischemic MR and LV remodeling without decreasing global or segmental LV function at follow-up.

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“…клапана (МК). Однак у частини пацієнтів ця процедура не ефективна: у віддалений період після операції настає рецидив МН у 19-59 % хворих [11,13,20,24]. Запропонована низка інших хірургічних підходів для лікування ішемічної МН, зокрема операції на лівому шлуночку (ЛШ) та на підклапанному апараті [3,8,11,15,21].…”

Section: оригінальні дослідженняunclassified

“…У нашу багатофакторну модель незалежних предикторів не увійшов КДР ЛШ (на відміну від дослідження L. Lee [19]), хоча він значуще відрізнявся у групах пацієнтів і мав значення при однофакторному аналізі. Більше прогностичне значення як незалежні фактори все-таки Наше дослідження підтверджує спостереження інших авторів про роль вираженого ремоделювання ЛШ у рецидиві МН через віддалений час після анулопластики [20,23,24]. При виборі способу хірургічного лікування хронічної ішемічної МН потрібно враховувати механізм МН, ступінь змін різних параметричних показників ремоделювання та вплив цих змін на клапан.…”

Section: результатиunclassified

Echocardiographic predictors of ischemic mitral insufficiency recurrence after mitral annuloplasty

Oryshchyn¹,

Ivaniv²

2018

CSIC

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І шемічна мітральна недостатність (МН) сприяє виникненню і наростанню явищ серцевої недостатності, що погіршує якість життя пацієнтів після інфаркту міокарда (ІМ) та скорочує тривалість життя [4, 6, 12, 17, 25]. Істотну ішемічну МН у хворого, якому рекомендована реваскуляризація, вважають показанням до хірургічного втручання на клапані [2]. При корекції ішемічної МН перевагу надають редукційній анулопластиці з/без імплантації штучного кільця мітрального

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Recurrent Mitral Regurgitation Late after Annuloplasty for Ischemic Mitral Regurgitation

Cited by 23 publications

References 29 publications

How Do Annuloplasty Rings Affect Mitral Annular Strains in the Normal Beating Ovine Heart?

How Do Annuloplasty Rings Affect Mitral Annular Strains in the Normal Beating Ovine Heart?

Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling

Echocardiographic predictors of ischemic mitral insufficiency recurrence after mitral annuloplasty

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