An integrated mechanism for functional mitral regurgitation: Leaflet restriction vs coapting force — In vitrostudies

He, Shenqiu; Fontaine, Arnold A.; Ellis, Jeffrey T.; Schwammenthal, Ehud; Yoganathan, Ajit P.; Levine, Robert A.

doi:10.1016/s0735-1097(96)81826-2

Cited by 103 publications

(183 citation statements)

References 0 publications

Supporting

Mentioning

169

Contrasting

Unclassified

Order By: Relevance

“…This finding supports the suggestion that LV systolic pressure probably acts on prolapse-like leaflet asynergy in an opposite way from funnel-shaped leaflet asynergy. 12,[21][22][23] …”

Section: Mr Jet Characteristics and Evolution Of Mr Severitymentioning

confidence: 99%

“…6 -11 With recent advances in 3D imaging techniques, geometric changes of the mitral apparatus accompanied by distortion of the LV chamber from which the PMs arise have been explored. [12][13][14][15][16][17] In these studies, leaflet tethering by the displaced PMs due to regional or global LV dysfunction has been suggested as a main mechanism of functional MR. However, the geometry of the mitral apparatus accompanied by regional or global LV dilatation has not been clarified differentially.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation

et al. 2003

View full text Add to dashboard Cite

Background-This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). Methods and Results-Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, A␣; posterior, P␣) were measured. In ICM-MR, A␣ measured in the medial and central planes was significantly larger than that in the lateral plane (39Ϯ5°, 34Ϯ6°, and 27Ϯ5°, respectively; PϽ0.01), whereas P␣ showed no significant difference in any of the 3 AP planes (61Ϯ7°, 57Ϯ7°, and 56Ϯ7°, PϾ0.05). In DCM-MR, both A␣ (38Ϯ8°, 37Ϯ9°, and 36Ϯ7°, PϾ0.05) and P␣ (59Ϯ6°, 58Ϯ5°, and 57Ϯ6°, PϾ0.05) revealed no significant differences in the 3 planes. Conclusions-The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.

show abstract

“…This finding supports the suggestion that LV systolic pressure probably acts on prolapse-like leaflet asynergy in an opposite way from funnel-shaped leaflet asynergy. 12,[21][22][23] …”

Section: Mr Jet Characteristics and Evolution Of Mr Severitymentioning

confidence: 99%

mentioning

confidence: 99%

Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation

et al. 2003

View full text Add to dashboard Cite

show abstract

“…A insuficiência valvar mitral é comum em pacientes portadores de CMD isquêmica ou idiopática e, embora o verdadeiro mecanismo da insuficiência funcional não esteja ainda totalmente esclarecido, admite-se concomitância de fatores como o deslocamento dos músculos papilares, o tracionamento das inserções valvares junto ao anel fibroso, e a diminuição da força contrátil do ventrículo esquerdo arrefecendo a pressão transvalvar como prováveis fatores etiológicos (14) .…”

Section: Comentáriosunclassified

“…Esses dados são conflitantes com os dados da literatura, que desconsideram o crescimento da porção fibrosa do anel (1,14,19) e daqueles autores (7,20,21) que admitem um crescimento mínimo.…”

Section: Gráfico 5 Perímetro De Inserção Das Cúspides Anteriorunclassified

Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada

Hueb¹,

Jatene²,

Moreira³

et al. 2001

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

P M A, Mioto B M, Chabelmann R C, Oliveira S A -Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada. Material e Métodos: Analisaram-se 68 corações humanos adultos, fixados, sendo 48 portadores de CMD de etiologia isquêmica ou idiopática, e 20 corações sem cardiopatia. Obteve-se imagens digitalizadas do perímetro do anel mitral, inserção da cúspide anterior e posterior e da porção fibrosa e muscular. Obteve-se também o perímetro interno do VE, distância do septo ao músculo papilar anterior e posterior, distância entre os músculos papilares, e extensão do septo interventricular.Resultados: A análise dos resultados demonstrou proporcionalidade, tanto da porção fibrosa (r 2 = 0.98), quanto da porção muscular (r 2 = 0.99) do anel em relação ao grau de dilatação da valva mitral. A regressão linear revelou que o perímetro de inserção das cúspides anterior (r 2 = 0.96) e posterior (r 2 =0.98) também guardam relação de proporcionalidade. Observou-se que a dilatação do VE ocorre de forma global e esférica em seus segmentos. Não se observou relação de proporcionalidade entre o grau de dilatação do anel mitral e do VE.Conclusão: Ao contrário do que se pensava, na CMD de etiologia isquêmica ou idiopática, a dilatação do anel mitral ocorre de forma proporcional e não apenas na sua porção posterior. Não é o grau de dilatação do VE que determina o grau de dilatação do anel mitral pois eles ocorrem de forma independente. Estas observações abrem novas perspectivas para as técnicas de correção da insuficiência valvar mitral na CMD.

show abstract

“…This results in an imbalance between the closing (LV contractility, LV electrical synchrony, and annular contraction) and tethering (papillary muscle displacement, LV remodeling, annular dilation) forces of the functional mitral unit leading to FMR. 6 The 2 most common etiologies of FMR are nonischemic and ischemic dilated cardiomyopathy.…”

Section: Functional/secondary Mitral Regurgitationmentioning

confidence: 99%

Percutaneous Treatment of Mitral Regurgitation: Present and Future

Athappan

Sorajja

Gössl

2017

Journal of the Minneapolis Heart Institute Foundation

View full text Add to dashboard Cite

Mitral valve regurgitation poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe mitral valve regurgitation. Surgical correction with mitral valve repair or replacement is the mainstay of therapy. However, a significant proportion of elderly patients are not eligible for mitral valve repair or replacement due to prohibitive surgical risk from increased age, poor ventricular function, or associated comorbidities. Percutaneous mitral valve repair/ replacement techniques have been developed to fill this void. The most advanced percutaneous technique with the highest safety and efficacy to date is the edge-to-edge MitraClip repair system. The majority of other catheter-based mitral valve repair/ replacement devices are at early developmental stages, but have shown encouraging initial results in feasibility trials. Transcatheter mitral valve replacement holds promise to emerge as the leading transcatheter treatment of choice in the future. KEY WORDS degenerative MR, functional MR, MitraClip, TMVR n INTRODUCTIONMitral valve regurgitation (MR) poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe MR.1 Left untreated, chronic MR results in heart failure symptoms, left ventricular cavity dilation and systolic dysfunction, left atrial enlargement, atrial fibrillation (AF), and pulmonary hypertension. In patients with severe primary/degenerative MR, an early repair of the structural defect is crucial to avoid irreversible sequela.2 In patients with secondary/functional MR, optimal medical therapy is a key component in the treatment of the underlying cardiomyopathy and may provide relief from symptoms. However, unless the cardiomyopathy and secondary/functional MR improves significantly under therapy, surgical or interventional options need to be considered. 3 Surgical correction with mitral valve repair (MVRe) or replacement (MVR) remain the mainstay of therapy for primary and secondary MR. Even so, because of the invasive nature of open-heart surgery (OHS) and the frequent presence of comorbidities in this group, up to 50% of patients with severe MR may not be offered surgery.4 This is especially true for older patients with multiple comorbidities and those with impaired left ventricular function. As a result, percutaneous technology is poised to significantly alter the treatment paradigm for chronic MR. Percutaneous MVRe or MVR offers the potential benefit of decreased morbidity, improved recovery time, and shorter hospital stays compared with OHS. In this review we summarize the devices that have been developed for percutaneous transcatheter mitral valve repair or replacement and their preliminary clinical results. Anatomy of the Mitral Valve ComplexAn appreciation of the complex anatomy of the mitral valve is of importance to understand the challenges in development of percutaneous MVRe or MVR technologies and for selection of the most optimal repair/replacement technique.T...

show abstract

An integrated mechanism for functional mitral regurgitation: Leaflet restriction vs coapting force — In vitrostudies

Cited by 103 publications

References 0 publications

Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation

Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation

Estudo comparativo do anel valvar mitral e do ventrículo esquerdo na cardiomiopatia dilatada

Percutaneous Treatment of Mitral Regurgitation: Present and Future

Contact Info

Product

Resources

About