The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique

Maisano, Francesco; Schreuder, Jan J.; Oppizzi, Michele; Fiorani, Brenno; Fino, Carlo; Alfieri, Ottavio

doi:10.1016/s1010-7940(00)00351-1

Cited by 177 publications

(95 citation statements)

References 6 publications

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“…3 As understanding of the pathophysiology of IMR has evolved, innovative mitral reparative surgical techniques, both at the annular and subvalvular level, have been proposed. 4,5 The Alfieri edge-to-edge mitral repair 6 has been used to treat various forms of mitral pathology, [7][8][9] including ischemic and functional mitral regurgitation. 10,11 This technique, usually with concomitant ring annuloplasty, 12 offers an expedient and simple method for certain forms of mitral pathology.…”

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confidence: 99%

Edge-to-Edge Mitral Valve Repair Without Ring Annuloplasty for Acute Ischemic Mitral Regurgitation

et al. 2003

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Background-Alfieri edge-to-edge mitral repair has been used clinically with ring annuloplasty to correct ischemic mitral regurgitation (IMR), but its efficacy without concomitant ring annuloplasty has not been described in this setting. Methods-Seventeen sheep underwent implantation of 9 radiopaque markers on the left ventricle, 8 on the mitral annulus (MA), 1 on each papillary muscle (PM) tip, and 1 on the anterior and posterior leaflet edges near the anterior and posterior commissures. Alfieri repair was performed in 7 animals, and 10 were controls. Biplane videofluoroscopy and transesophageal echocardiography (TEE) were performed (open chest) before and continuously during left circumflex coronary artery occlusion to induce acute IMR. MA area (MAA), anterior (APM), and posterior (PPM) papillary muscle tip distances to midseptal MA ("saddle horn"), and distance of each leaflet marker to the mitral annular plane were calculated from 3-dimensional marker coordinates at end-systole (ES

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confidence: 99%

Edge-to-Edge Mitral Valve Repair Without Ring Annuloplasty for Acute Ischemic Mitral Regurgitation

et al. 2003

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“…As the technique is based on approximating central edges of the mitral leaflets with sutures, the repair is usually reinforced with concomitant ring annuloplasty in standard 3,4 and minimally invasive 20 surgical approaches to ameliorate concerns about limited durability. New percutaneous interventional procedures simulating the edge-to-edge repair do not currently include such annular reduction, 11,21 which may predispose the patient to premature repair failure if the leaflet approximating clip or suture pulls free.…”

Section: Discussionmentioning

confidence: 99%

“…2 The Alfieri edge-to-edge mitral repair is a recent simple addition to the evolving surgical armamentarium. This technique, in conjunction with ring annuloplasty, has been successfully applied to correct various etiologies of mitral insufficiency, [3][4][5][6] even in patients with challenging mitral pathophysiology. 7,8 The procedure also lends itself to minimally invasive methods, and beating heart 9 and percutaneous 10 edgeto-edge mitral repair has been described in animal models and clinical trials of catheter-based repair are ongoing.…”

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confidence: 99%

Effect of Chronotropy and Inotropy on Stitch Tension in the Edge-to-Edge Mitral Repair

Timek

Nielsen²,

Lai³

et al. 2007

Circulation

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Background-Our prior studies suggest that mitral annular septal-lateral (SL) diameter is the chief determinant of "Alfieri stitch" tension, but hemodynamic parameters may also play a role. We approximated the central edge of the mitral leaflets with a miniature force transducer to measure tension (T) at the leaflet approximation point during inotropic and chronotropic stimulation. Methods and Results-Eight sheep were studied under open-chest conditions immediately after surgical placement of a miniature force transducer to approximate the leaflets and implantation of radiopaque markers on the LV and mitral annulus (MA). Chronotropic stimulation was induced with atrial pacing at 130 minutes Ϫ1 (nϭ5) whereas inotropic state was increased with IV CaCl 2 bolus (nϭ8). Hemodynamic data, stitch tension, and 3-D marker coordinates were obtained throughout the cardiac cycle before and during each intervention. Peak stitch tension (T MAX ) under all conditions was observed in diastole and temporally correlated with peak annular SL (SL MAX ) size. Atrial pacing did not change peak transducer tension or annular size. Calcium infusion also did not alter peak transducer tension (0.29Ϯ0.11 versus 0.32Ϯ0.10 N; PϭNS) and only slightly reduced SL dimension (29.9Ϯ3.3 versus 29.3Ϯ3.5 mm; PϽ0.05). Conclusion-Isolated increase in heart rate or inotropic state did not alter peak stitch tension whereas enhanced contractile state decreased SL diameter minimally. These data, combined with those from our previous study, suggest that geometric (SL diameter) rather than hemodynamic parameters are the main determinants of "Alfieri stitch" tension. This implies that any interventional or surgical edge-to-edge repair performed without concomitant annular reduction to limit the SL dimension could expose the leaflet junction to forces which could limit repair durability.

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“…3a), cleft suture, 5-0 polytetrafluoroethylene sutures from the single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique (Fig. 3b), 1) and ring plasty with 32-mm semi-rigid ring was performed (Fig. 3c).…”

Section: Introductionmentioning

confidence: 99%

Successful Surgical Repair of the Parachute Mitral Valve with Mitral Valve Regurgitation

Shiraishi

Yamaguchi

Adachi

2012

ATCS

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A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.Keywords: parachute mitral valve, single papillary muscle, mitral valve regurgitation, mitral valve plasty Case ReportA 65-year-old woman who had exercise-related dyspnea was admitted to our hospital for evaluation. She had been asymptomatic before presentation. On physical examination, there was a grade 4/6 holosystolic regurgitant murmur audible throughout the precordium. The peripheral pulses were normal, and the rest of her examination was unremarkable. Anteroposterior chest X-ray demonstrated no cardiomegaly showed a sinus rhythm with a rate of 66/min, and complete right bundle branch block. A two-dimensional and color Doppler echocardiogram was performed. It demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle with a dilated left atrium and left ventricle, and a cleft in the posterior leaflet of the mitral valve (Fig. 1a). Color Doppler showed severe mitral valve regurgitation in systole (Fig. 1b). Pulse-Doppler recording of transmitral flow from the left ventricle apex demonstrated no features of mitral valve stenosis (Fig. 1c). Cardiac catheterization was performed which confirmed the diagnosis and demonstrated hyperkinetic pulmonary artery

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The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique

Abstract: The double-orifice repair can be used as a standardized approach to treat valve regurgitation due to Barlow disease with low risk and good early and mid-term results.

Cited by 177 publications

References 6 publications

Edge-to-Edge Mitral Valve Repair Without Ring Annuloplasty for Acute Ischemic Mitral Regurgitation

Edge-to-Edge Mitral Valve Repair Without Ring Annuloplasty for Acute Ischemic Mitral Regurgitation

Effect of Chronotropy and Inotropy on Stitch Tension in the Edge-to-Edge Mitral Repair

Successful Surgical Repair of the Parachute Mitral Valve with Mitral Valve Regurgitation

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