Relocation of Papillary Muscles for Ischemic Mitral Valve Regurgitation

Autor: Pietro Dioguardi, Giuseppe Speziale, Giacomo Murana, Giuseppe Bianco, Khalil Fattouch, Giuseppe Nasso, Francesco Guccione, Sebastiano Castrovinci
Přispěvatelé: Fattouch, K., Castrovinci, S., Murana, G., Dioguardi, P., Guccione, F., Bianco, G., Nasso, G., Speziale, G.
Rok vydání: 2014
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Mitral Valve Annuloplasty
Myocardial ischemia
medicine.medical_treatment
Treatment outcome
Myocardial Ischemia
Echocardiography
Three-Dimensional
Three-dimensional echocardiography
Papillary Muscle
Ischemic mitral valve regurgitation
Intraoperative Period
Retrospective Studie
Internal medicine
Mitral valve
Mitral valve annuloplasty
medicine
Humans
Retrospective Studies
Aged
Mitral valve repair
Ischemic mitral regurgitation
business.industry
Mitral Valve Insufficiency
General Medicine
Papillary Muscles
medicine.disease
Feasibility Studie
Treatment Outcome
medicine.anatomical_structure
Cardiology
Feasibility Studies
Female
Surgery
business
Mitral valve regurgitation
Cardiology and Cardiovascular Medicine
Echocardiography
Transesophageal
Human
Zdroj: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 9:54-59
ISSN: 1559-0879
1556-9845
DOI: 10.1177/155698451400900110
Popis: Objective The assessment of the mitral valve apparatus (MVA) and its modifications during ischemic mitral regurgitation (IMR) is better performed by three-dimensional (3D) transesophageal echocardiography (TEE). The aim of our study was to carry out nonrestrictive mitral annuloplasty in addition to relocation of papillary muscles (PPMs) oriented by preoperative real-time 3D TEE through the mitral valve quantification dedicated software. Methods Since January 2008, a total of 70 patients with severe IMR were examined both before and after mitral valve repair. The mean (SD) coaptation depth and the mean (SD) tenting area were 1.4 (0.4) cm and 3.2 (0.5) cm2, respectively. Intraoperative 3D TEE was performed, followed by a 3D offline reconstruction of the MVA. A schematic MVA model was obtained, and a geometric model as a “truncated cone” was traced according to preoperative data. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth of approximately 6 mm was used to detect the new position of the PPMs tips. Results Perioperative offline reconstruction of the MVA and the respective truncated cone was feasible in all patients. The expected position of the PPMs tips, desirable to reach a normal tenting area with a coaptation depth of 6 mm or more, was obtained in all patients. After surgery, all parameters were calculated, and no statistically significant difference was found compared with the expected data. Conclusions Relocation of PPMs plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results in patients with severe IMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.
Databáze: OpenAIRE
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