Wrinkle-induced tear in the mitral valve leaflet tissue: a computational model

Goode, Dylan; Kermen, Emre; Mohammadi, Hadi

doi:10.1080/03091902.2020.1799091

Cited by 1 publication

(2 citation statements)

References 18 publications

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“…In the AR test, the recorded intraventricular pressure, measured through the aspiration branch of the cardioplegic line, was between 60 and 80 mmHg in line with the values of 70 and 90 mmHg reported by Tachibana et al [11,12]. These pressure values are estimated to be effective enough to determine a proper tension of the mitral valve structures and thus can give a reliable result of the repair [14]. In addition, an antegrade reperfusion flow of 300-350 mL/minute is used in our practice.…”

Section: Discussionsupporting

confidence: 85%

“…At this stage, the left fibrous trigone of the heart is subjected to high mechanical stress. The aortic valve and the mitral valve are in close contact at the level of the left trigone so that the anterior commissure of the mitral valve is affected by mechanical modifications in a significant way leading to a wrinkle-induced tear in the mitral valve leaflet tissue [14].…”

Section: Discussionmentioning

confidence: 99%

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The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair

Youssari¹,

Couëtil²,

Piscitelli³

et al. 2021

Reviews in Cardiovascular Medicine

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Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary by-pass, remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%