Cine-Angiographic Studies of the Pathophysiologic Sequelae of Experimental Papillary Muscle Damage in Dogs

Underwood, F. O.; Sybers, R. G.; Ferrier, F; Symbas, Panagiotis N.

doi:10.2214/ajr.108.4.702

Cited by 4 publications

(2 citation statements)

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“…The role of papillary muscle shortening under tension in the functioning heart may be to adjust to these length changes during systole so that the remainder of the mitral valve apparatus (chordae tendineae plus mitral valve) does not become slack and thereby permit mitral regurgitation. This theory is supported by experimental evidence in dogs (29,30) as well as by data obtained in certain pathological states in humans (31)(32)(33).…”

Section: Discussionsupporting

confidence: 54%

Papillary muscle shortening in the intact dog; a cinderadiographic study of tranquilized dogs in the upright position.

Grimm¹,

Lendrum²,

Lin³

1975

Circulation Research

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Shortening of the anterior papillary muscle of the left ventricle was demonstrated in six intact, tranquilized dogs. Two small metal markers that had been surgically implanted 3-50 months earlier were cineradiographically photographed during approximately ten sequential cardiac cycles in each of two orthogonal positions. Distances between markers were plotted for successive frames. The resulting curves were used to obtain maximum velocities of papillary muscle shortening and lengthening: 1.08 ± 0.29 muscle lengths/sec and 1.39 ± 0.48 muscle lengths/sec, respectively. From the two orthogonal planes, the average maximum spatial distance and the average minimum spatial distance between the markers were calculated. The mean percent shortening of 22.8 ± 6.5% was surprisingly large: it approximated the distance from the foot to the peak of the ascending limb of the myocardial lengthtension curve derived from isolated muscle studies. Mechanical studies on isolated papillary muscle have consistently shown reduced shortening with increasing loads. Since the in vivo dog papillary muscle has been reported to be under considerable tension during systole, there appears to be some contradiction between the degree of shortening found in the present study and the shortening observed in isolated papillary muscle studies. KEY WORDSmvocardial shortening length-tension curves cardiac metal markers myocardial velocities electrocardiogram• Papillary muscle has been investigated for two relatively independent reasons: (1) it is an experimentally convenient sample of ventricular myocardium, and (2) it is a clinically important portion of the functioning heart. Papillary muscle is easy to isolate and to remove from the ventricle. Its small diameter in some species and its participation during cardiac growth also contribute to its utility as an experimental material. Most papillary muscle studies have employed the isolated muscle (1-10), although more recently mechanical properties have been studied in the in situ muscle (11)(12)(13)(14). The essentially linear fiber arrangement within the muscle greatly simplifies the interpretation This work was supported in part by U. S. Public Health Service Grant 1 R01 HL-14651-01 from the National Heart and Lung Institute.A preliminary report on some of these results has been previously presented in abstract form (Fed Proc 27:2699, 1968.Received July 2, 1973. Accepted for publication September 6, 1974. Circulation Research, Vol. 36, January 1975 of data from both mechanical and microscopic studies (15).Papillary muscle function in the intact heart has, most often, been deduced indirectly from isolated muscle studies, clinical observations, autopsy reports, and theoretical considerations. Burch et al. (16) and Burch and Depasquale (17) have postulated that during ventricular systole the papillary muscle, by creating tension, acts as a stay to restrict mitral valve motion. When normal tension development does not occur, excessive mitral valve motion results in mitral regurgitation (the p...

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Section: Discussionsupporting

confidence: 54%

Papillary muscle shortening in the intact dog; a cinderadiographic study of tranquilized dogs in the upright position.

Grimm¹,

Lendrum²,

Lin³

1975

Circulation Research

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“…Investigative work done by Underwood et al (1970) and Mittall et al (1971) in dogs has shown that experimentally induced ischemia in papillary muscles does not commonly lead to mitral regurgitation unless there is involvement of the adjoining free ventricular wall. The degree of ischemic compromise of the remaining left ventricle is an additional major factor in determining the magnitude of the regurgitation.…”

Section: Clinical Presentationmentioning

confidence: 99%

Ruptured papillary muscle, a complication of myocardial infarction: Clinical presentation, diagnosis, and treatment

Clements

Story

Hurst

et al. 1985

Clinical Cardiology

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Summary: Ruptured papillary muscle due to myocardial infarction was encountered in 14 patients during the period [1975][1976][1977][1978][1979][1980][1981][1982][1983]. Five of the 14 patients had a history of angina pectoris and two had a history of prior myocardial infarction. Eleven patients with myocardial infarction developed additional pain due to myocardial ischemia and/or a murmur of mitral regurgitation and pulmonary edema within a week, 3 others had a prolonged course with intermittent pain due to myocardial ischemia and breathlessness for longer periods and then deteriorated. Thirteen of our 14 patients developed a murmur and all but one had pulmonary edema on the chest x-ray. Five patients had infarction patterns on the electrocardiogram, the remainder of the patients had only ST-and T-wave changes.Echocardiograms showed fine flutter and notching of the anterior mitral leaflets and vigorous contractions of the left ventricle. Only one patient was demonstrated to have a papillary muscle tip prolapsing into the left atrium on two-dimensional echocardiography . Twelve patients underwent surgery and 8 survived. Seven patients had singlevessel coronary disease, 4 involving the circumflex system and 3 involving the right coronary system. Four of the 7 patients with single-vessel coronary disease survived surgery. Five patients went to surgery with the intra-aortic balloon pump in place and only 3 survived. Three others had the pump inserted intraoperatively and 2 of these survived. Six of 9 patients who had mitral valve replacement and coronary bypass survived. Ejection fraction ranged from 40 to 79 % . Surgical survival did seem to be related to the extent of papillary muscle rupture, with the best results occurring in the group with a small portion of the tip ruptured. Seven patients had a stormy clinical course and required surgery within 10 days of rupture. Four of these 7 survived. It seems reasonable to believe that these patients who often have small infarction and limited coronary disease have good potential for survival. Our approach has been to move toward surgery once the diagnosis is made to avoid the sudden deterioration that frequently occurs. The surgical mortality in this group remains in the 30 to 40% range.

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Acquired, nonrheumatic mitral regurgitation: Clinical management with emphasis on evaluation of myocardial performance

Kremkau¹,

Gilbertson²,

Bristow³

1973

Progress in Cardiovascular Diseases

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Cine-Angiographic Studies of the Pathophysiologic Sequelae of Experimental Papillary Muscle Damage in Dogs

Cited by 4 publications

References 0 publications

Papillary muscle shortening in the intact dog; a cinderadiographic study of tranquilized dogs in the upright position.

Papillary muscle shortening in the intact dog; a cinderadiographic study of tranquilized dogs in the upright position.

Ruptured papillary muscle, a complication of myocardial infarction: Clinical presentation, diagnosis, and treatment

Acquired, nonrheumatic mitral regurgitation: Clinical management with emphasis on evaluation of myocardial performance

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