Structural Characterization of the Chordae Tendineae in Native Porcine Mitral Valves

Ritchie, Judith A.; Warnock, James N.; Yoganathan, Ajit P.

doi:10.1016/j.athoracsur.2005.02.011

Cited by 45 publications

(36 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mitral valve leaflets have similar layers as the aortic valve, whereas the chordae tendinae contains large number of longitudinally oriented collagen fibers. 86 The blood vessel structure consists of three layers: Intima, a layer of endothelial cells in direct contact with the blood flow and an underlying connective tissue; Media, sheets of smooth muscles with connective tissues in between; and Adventitia, a layer of fibrous connective tissue covering the outermost part of the vessels (Figs. 1c, 1d).…”

Section: Introductionmentioning

confidence: 99%

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

Masjedi

Ferdous

2015

Cardiovasc Eng Tech

View full text Add to dashboard Cite

Cardiovascular disease (CVD) is the major cause of mortality in the elderly population. The cost of CVD treatment and surgeries was over $300 billion in the United States alone in 2010, making this disorder a critical healthcare issue. Many studies have suggested sex as a risk factor for heart valve and major vascular diseases, such as aortic valve stenosis, mitral prolapse and regurgitation, atherosclerosis, coronary artery disease, and abdominal aortic aneurysm. Unfortunately, only a handful of studies have illustrated the role of sex in the etiology and progression of these disorders. Moreover, knowledge of biomolecular factors that affect these diseases in men and women is very limited. Numerous clinical studies have revealed obvious differences in the prevalence of these diseases between the sexes. These reports were supported by a few molecular and cellular physiology studies that associated this difference to sex and sex hormones. In particular, male sex has commonly been identified as a risk factor for majority of heart valve and vascular diseases, whereas females have been identified as higher risk for certain disorders as well. In addition, menopause is a critical issue that turns the tables against women and enhances complications in their cardiovascular structure due to hormonal change. In this review, major vascular and heart valve diseases for which sex is associated as a risk factor have been reviewed to highlight the importance of this risk factor in CVDs.

show abstract

Section: Introductionmentioning

confidence: 99%

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

Masjedi

Ferdous

2015

Cardiovasc Eng Tech

View full text Add to dashboard Cite

show abstract

“…The normally convex MV closing configuration towards left atrium becomes concave, and the anterior MV leaflet appears like a 'hockey stick' on Echo. 9 Once the necessary leaflet tissue redundancy for MV coaptation is exhausted, MR will develop, which will over time further advance annular remodelling and tethering by the collagen-based chordae 6,7,10 and therefore MR ( Figure 1A).…”

mentioning

confidence: 99%

The power of ultrasound: treating secondary MR with sound waves

Dal‐Bianco¹,

Bartko²,

Levine³

2016

Eur Heart J Cardiovasc Imaging

View full text Add to dashboard Cite

Innovations in physics and its applications often enable medical advances. Collaboration between physicists who developed a high-frame-rate ultrasound system and cardiovascular investigators has allowed non-invasive measurement of vascular and myocardial stiffness. 1,2 In this current issue of the European Heart JournalCardiovascular Imaging, members of these groups, using a related technology, have employed ultrasound to treat as well as to image the heart 3 in mitral regurgitation (MR) secondary to myocardial infarction (MI) that causes mitral valve (MV) leaflet tethering mediated by chordae to the displaced papillary muscles (PMs). 4 This is a condition for which a strong need is perceived for improved approaches. 5 Although there is evidence for adaptive MV growth in secondary MR,6,7 this extra leaflet tissue is often insufficient to compensate adequately for mitral annular (MA) enlargement and chordal tethering. 8 The MV leaflets thus become increasingly taut, being pulled by the annulus towards the base, and by chordae towards the left ventricular (LV) apex. The normally convex MV closing configuration towards left atrium becomes concave, and the anterior MV leaflet appears like a 'hockey stick' on Echo. 9 Once the necessary leaflet tissue redundancy for MV coaptation is exhausted, MR will develop, which will over time further advance annular remodelling and tethering by the collagen-based chordae 6,7,10 and therefore MR ( Figure 1A).Current medical and surgical and transcatheter repair therapies for secondary MR thus aim to reduce overall leaflet tethering to restore leaflet coaptation by addressing the impaired LV (optimal medical heart failure therapy, revascularization, resynchronization, potential myocardial regeneration) and the mitral annulus (restoration of normal sinus rhythm, annuloplasty). Not as clinically established, but shown to be safe and effective is to directly target the chordal apparatus by cutting secondary chordae attaching to the leaflet bodies to relieve their tethering and to restore a greater surface for leaflet coaptation 11,12 ( Figure 1B). Such chordal cutting reduces both MR and its associated LV remodelling 13 and has been successfully applied by several surgical groups. 14 -16 The pathological changes observed in chordae post-infarction 7 and the recent reported relation between secondary MR and chordal shortening, imposing additional restriction on the tethered leaflets, lend further support to the potential benefits of chordal cutting to relieve such MR. 17 The current paper reports a proof of concept for using pulsed cavitational focused ultrasound (histotripsy) to cut chordae non-invasively guided by real-time 3D echocardiography. 3 The authors show that secondary anterior chordae can be selectively cut in vitro and in vivo in the beating sheep heart with a high-energy Figure 1 (A) Functional/ischaemic MR: the PM is displaced posteriorly, laterally, and apically because of local LV dilatation and remodelling (arrows) caused by MI (shaded area). This LV wall-PM displace...

show abstract

“…Ambos, cúspide e corda tendínea são recobertos por uma simples e contínua camada de células endoteliais 16 . Na porção fibrosa da cúspide e da corda tendínea, as fibras colágenas estão intermixadas com fibras elásticas, ambas associadas com proteoglicanos 11,16,17,18 . As cordas tendíneas exibem uma quantidade de colágeno significantemente maior e menos elastina do que nas cúspides mitrais.…”

Section: Estrutura Da Corda Tendíneaunclassified

“…RITCHIE et al (2006) desenvolveram uma técnica não-destrutiva para medir a tensão na corda da valva mitral de suínos, permitindo uma investigação no comportamento de tecidos biológicos sob condições de carga fisiológica 18 . As medições geométricas permitem concluir que as posições anatômicas da corda estão relacionadas com o ponto de inserção no músculo papilar, de modo que as cordas exercem as mesmas forças mecânicas de cada lado do folheto anterior.…”

Section: Resistência Mecânicaunclassified

See 1 more Smart Citation

Análise do efeito do laser de alta potência em valvas mitrais cardíacas de suínos: estudo experimental

Pinto¹

View full text Add to dashboard Cite

Structural Characterization of the Chordae Tendineae in Native Porcine Mitral Valves

Cited by 45 publications

References 18 publications

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

The power of ultrasound: treating secondary MR with sound waves

Análise do efeito do laser de alta potência em valvas mitrais cardíacas de suínos: estudo experimental

Contact Info

Product

Resources

About