Impact of abrupt versus gradual correction of mitral and tricuspid regurgitation: a modelling study
| Autor: | Richard Cornelussen, John Walmsley, Ulrich Wolfhard, Joost Lumens, Pierre Squara |
|---|---|
| Přispěvatelé: | RS: CARIM - R2.09 - Cardiovascular system dynamics, Biomedische Technologie, RS: Carim - H07 Cardiovascular System Dynamics |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
PREDICTION SURGERY Heart Ventricles Hypertension Pulmonary Regurgitation (circulation) 030204 cardiovascular system & hematology VALVE-REPLACEMENT 03 medical and health sciences 0302 clinical medicine LEFT-VENTRICULAR FUNCTION Clinical investigation Internal medicine medicine Humans preclinical research 030212 general & internal medicine Heart Atria ADAPTATION TRABECULAE REPAIR HYPERTENSION business.industry MORTALITY Mitral Valve Insufficiency Atrial contractility medicine.disease Pulmonary hypertension innovation Tricuspid Valve Insufficiency specific closure device/technique Blood pressure tricuspid disease Cardiology HEART mitral regurgitation Cardiology and Cardiovascular Medicine business |
| Zdroj: | Eurointervention, 15(10), 902-911. Europa Digital & Publishing |
| ISSN: | 1969-6213 1774-024X |
| Popis: | Aims: Correction of mitral and/or tricuspid regurgitation (MR, TR) frequently leads to poor outcomes in the days following intervention. We sought to understand how abrupt correction of MR and TR affects ventricular load and to investigate if gradual correction is beneficial.Methods and results: MR and TR were simulated using the CircAdapt cardiovascular system model with effective regurgitant orifice (ERO) areas of 0.5 cm(2) and 0.7 cm(2). Ventricular and atrial contractility reductions to 40% of normal and pulmonary hypertension were simulated. Abrupt and gradual ERO closure were simulated with homeostatic regulation of blood pressure and volume. Abrupt correction of MR increased left and right ventricular fibre stress by 40% and 15%, respectively, whereas TR correction increased left and right ventricular fibre stress by 26% and 19%, respectively. This spike was followed by a rapid drop in fibre stress. Myocardial dysfunction prolonged the spike but reduced its amplitude. Right ventricular fibre stress increased more with pulmonary hypertension and TR. Gradual correction demonstrated no spike in tissue load.Conclusions: Simulations demonstrated that abrupt ERO closure creates a transient increase in ventricular load that is prolonged by worsened myocardial condition and exacerbated by pulmonary hypertension. Gradual closure of the ERO abolishes this spike and merits clinical investigation. |
| Databáze: | OpenAIRE |
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