6533b861fe1ef96bd12c5015
RESEARCH PRODUCT
Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation.
Giovanni RuvoloEmanuela Clara BertolinoGiuseppa CaccamoSebastiano CastrovinciPatrizio LancellottiRoberta SampognaroGiacomo MuranaKhalil FattouchClaudia MossutoMaria Giuliana Borrusosubject
Pulmonary and Respiratory Medicinemedicine.medical_specialtyMitral Valve Annuloplastymedicine.medical_treatmentEchocardiography Three-DimensionalSeverity of Illness Index3 dimensional transesophageal echocardiographyBlood Vessel Prosthesis ImplantationPredictive Value of TestsMitral valve annuloplastyInternal medicineMitral valveImage Interpretation Computer-AssistedMedicineHumansFunctional mitral regurgitationPapillary muscleAgedMitral valve repairMitral regurgitationbusiness.industryRing annuloplastyMitral Valve InsufficiencySettore MED/23 - Chirurgia CardiacaMiddle AgedPapillary Musclesmedicine.anatomical_structureTreatment OutcomeMitral valve annuloplastyItalycardiovascular systemCardiologyMitral ValveSurgeryCardiology and Cardiovascular MedicinebusinessEchocardiography Transesophagealdescription
Objective The study of the mitral valve apparatus and its modifications during functional mitral regurgitation (FMR) is better revealed by 3-dimensional (3D) transesophageal echocardiography (TOE). To plan mitral valve repair by annuloplasty and papillary muscle (PPM) relocation, we proposed a valve repair procedure oriented by the new main features obtained by real-time 3D TOE reconstruction of the mitral valve apparatus. Methods Since January 2008, 25 patients with severe FMR before mitral valve repair were examined. Mean coaptation depth and mean tenting area were 1.3 ± 0.2 cm and 3.2 ± 0.5 cm 2 , respectively. Intraoperative 2D and 3D TOE were performed, followed by a 3D offline reconstruction of the mitral valve apparatus. A schematic mitral valve apparatus model was obtained. A geometric model like a truncated cone was traced in according to the preoperative measurements. The size of the prosthetic ring was selected preoperatively according to the anterior leaflet surface. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth about 0.6 cm was used to detect the new position of the PPM tips. Results Offline reconstruction of the mitral valve apparatus and respective truncated cone were feasible in all patients. The expected position of the PPM tips desirable to reach a normal tenting area with a coaptation depth 0.6 cm or less was obtained in all patients. After surgery, all parameters were calculated and no statistically significant difference was found compared with the expected data. Conclusions PPM relocation plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results for patients with severe FMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2012-04-01 | The Journal of thoracic and cardiovascular surgery |