Efficacy of chordal cutting in alleviating ischemic mitral regurgitation: insights from 3-dimensional echocardiography

Sai-Sudhakar, Chittoor; Vandse, Rashmi; Armen, Todd A.; Bickle, Katherine; Nathan, Neera

doi:10.1186/1749-8090-2-39

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…This provides increased leaflet coaptation through decreased tethering, and in combination with MVA has been shown to successfully correct IMR [97,98]. Borger et al [99] retrospectively evaluated 43 patients undergoing MVA + chordal cutting compared with 49 patients undergoing MVA alone.…”

Section: Other Repair Strategiesmentioning

confidence: 97%

Ischemic mitral regurgitation

Krishnaswamy¹,

Gillinov²,

Griffin³

2011

Coronary Artery Disease

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Secondary or 'functional' mitral regurgitation (MR) is often due to ischemic heart disease that results in disordered left ventricle and mitral valve geometry. In patients with coronary disease, concomitant MR results in worse morbidity and mortality. Coronary artery disease may result in annular dilation due to left ventricle cavity dilation, excessive leaflet motion, impaired leaflet motion due to leaflet tethering and papillary muscle displacement, and/or decreased mitral valve closing forces due to systolic dysfunction. Although transthoracic echocardiography is the first step in the diagnosis of ischemic MR, transesophageal and three-dimensional echocardiography are often useful adjuncts to better understand the mechanism(s) of disease and planning repair. Furthermore, noninvasive evaluation of ischemia and viability may provide important prognostic information. Medical therapy for ischemic MR is directed at the underlying ischemic substrate and concomitant systolic dysfunction, and consists of β-blockers and vasodilators. Percutaneous strategies for repair are currently under investigation, and have shown promising results. Surgical repair is favored over replacement, and is generally recommended for patients with moderate or severe MR undergoing coronary artery bypass. Unfortunately, long-term freedom from MR is elusive even with surgical repair, and trials are currently underway to determine the best approach to treatment in patients with moderate disease.

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Section: Other Repair Strategiesmentioning

confidence: 97%

Ischemic mitral regurgitation

Krishnaswamy¹,

Gillinov²,

Griffin³

2011

Coronary Artery Disease

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“…Specific chordae are targeted by assessing for the location and severity of leaflet tenting with 3DE. In conjunction with mitral valve annuloplasty, chordal cutting has been shown in some cases to reduce regurgitation severity [16]. There are multiple other surgical strategies aimed at reducing the amount of papillary muscle tethering under evaluation.…”

Section: Functional Mitral Regurgitationmentioning

confidence: 99%

Three-Dimensional Echocardiography and Mitral Valve Disease

Chapman

Rahko

2010

Curr Cardiol Rep

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Three-dimensional echocardiography is a growing imaging modality, particularly for the evaluation of mitral valve pathology. Functional anatomy in disease states such as mitral regurgitation and stenosis as well as prosthetic valves can be effectively studied, offering superior knowledge to treating physicians. Additionally, three-dimensional echocardiography has the ability to help guide operative and percutaneous interventions, allowing for improved patient outcomes and advancement of clinical research. Continued experience with three-dimensional echocardiography will further our knowledge of the mitral valve and refine current indications for cardiovascular imaging.

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“…Transection of ASC to relieve anterior leaflet tethering was proposed as an adjunct technique to annuloplasty to correct MR and improve leaflet coaptation in these patients 6–8 . Though clinical experience with this procedure is limited, the hemodynamic efficacy of this technique in chronic ischemic animal models is documented and its potential role in diminishing left ventricular (LV) remodeling is emerging 9 .…”

Section: Introductionmentioning

confidence: 99%

Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve

Padala

Gyoneva

Yoganathan

2012

The Journal of Thoracic and Cardiovascular Surgery

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BACKGROUND Transection of the secondary chordae on the anterior leaflet of the mitral valve to relieve leaflet tethering and reduce regurgitation is an experimentally proven procedure to correct functional mitral regurgitation. In this study, we sought to investigate if transecting the secondary chordae has an impact on the marginal chordal force on the same leaflet. METHODS Adult porcine mitral valves (N =8) were studied in a pulsatile heart simulator, in which the papillary muscle positions can be precisely positioned. The anterior marginal chordae were instrumented with miniature transducers to measure the chordal forces. Each valve was studied under baseline conditions, three different tethering conditions [apical, apical-lateral, apical-lateral-posterior], and following chordal cutting in the three tethering conditions. The temporal changes, the peak and average marginal chordal forces under each condition are reported. RESULTS Apical tethering increased marginal chordal force by an average 96% but remained unchanged after chordal cutting. With apical-lateral tethering, marginal chordal force increased by 210% from baseline, and further increased to 350% of baseline after chordal cutting. After apical-lateral-posterior tethering, the marginal chordal force increased to 335% of baseline before transection and by 548% after the transection. CONCLUSIONS Increase in marginal chordal force after secondary chordal cutting depends on the location of the papillary muscles and the extent of leaflet tethering. While, chordal cutting may not alter the valve mechanics under minimal leaflet tethering, it significantly impacts the mechanics when the leaflet tethering is more pronounced, which is typically seen in patients with functional mitral regurgitation.

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Efficacy of chordal cutting in alleviating ischemic mitral regurgitation: insights from 3-dimensional echocardiography

Cited by 7 publications

References 41 publications

Ischemic mitral regurgitation

Ischemic mitral regurgitation

Three-Dimensional Echocardiography and Mitral Valve Disease

Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve

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