Functional Mitral Regurgitation: Current Understanding and Approach to Management

Ducas, Robin; White, C.H.; Wassef, Anthony; Farag, Ashraf; Bhagirath, Kapil M.; Freed, Darren H.; Tam, James W.

doi:10.1016/j.cjca.2013.11.022

Cited by 17 publications

(13 citation statements)

References 58 publications

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“…It is a common complication of myocardial infarction thought to result from leaflet tethering caused by displacement of the papillary muscles that occurs as the left ventricle remodeling [26]. Postoperative mitral regurgitation score was not significantly different from those prior to operation in both groups in this study.…”

Section: Discussioncontrasting

confidence: 49%

“…Color flow imaging provides a rapid and semiquantitative assessment of valvular mitral regurgitation severity [18]. The ratio between the length of the regurgitant jet and the superoinferior dimension of the left atrium (apical four-chamber view) corresponded to the severity of mitral regurgitation: score 0-no regurgitation; score 1-regurgitation with an length of ≤1/3; score 2-regurgitation length of > 1/3 and ≤1/2; score 3-regurgitation with an length of ≥1/2.…”

Section: The Harvested Bmmncsmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

Duan

Liu

et al. 2015

Med Ultrason

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Aims: The graft of stem cells to treat ischemic cardiomyopathy is popular in many clinical trials. The aim of this study was to evaluate the effectiveness of isolated coronary artery bypass graft combined with bone marrow mononuclear cells (BMMNC) delivered through graft vessels to improve left ventricular remodeling of patients with previous myocardial infarction and chronic heart failure using echocardiography. Material and methods: Patients with previous myocardial infarction and chronic heart failure were randomly allocated to one of the two groups: CABG only (18 patients), or CABG with BMMNC transplantation (24 patients). Echocardiographic parameters were measured on B-mode imaging, 3D imaging and color flow imaging. Results Post-operative LVEDD (end-diastolic dimension of left ventricle), LVESD (end-systolic dimension of left ventricle), LVEDV (end-diastolic volume of left ventricle), LVESV (end-systolic volume of left ventricle), LVEDVI (LVEDV indexed to body surface area), LVESVI (LVESV indexed to body surface area), LV-mass (mass of left ventricle) and LVmassI (LV-mass indexed to body surface area) were significantly improved compared with those obtained prior to operation in CABG+BMMNC group (al p<0.05). The same parameters were not significantly different pre-and postoperative in the CABG group (al p>0.05). Postoperative mitral regurgitation score was not significantly different from those prior to operation in both groups (al p>0.05). In Chi-square tests, LVEDD, LVESD, LVEDV, LVESV, LVEDVI, LVESVI, LV-mass, LVmassI were determinants of the left ventricular remodeling. Conclusion: The improvement of left ventricular remodeling in CABG+BMMNC group was better than in the CABG group and this improvement was verified by echocardiography.

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Section: Discussioncontrasting

confidence: 49%

Section: The Harvested Bmmncsmentioning

confidence: 99%

Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

Duan

Liu

et al. 2015

Med Ultrason

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“…When the LV dilates, the mitral annulus also dilates and flattens, loses its saddle shape and systolic annular contraction. This causes malcoaptation of mitral leaflets, 22,23 and an increase in tethering forces resulting in less shortening of PMs. In addition, we found that posterior leaflet length was associated with PPMS.…”

Section: Discussionmentioning

confidence: 99%

Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation

Kılıçgedik

Kahveci

Gürbüz

et al. 2017

Arquivos Brasileiros De Cardiologia

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FundamentoThe role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy.ObjectivesTo evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method.Methods64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging.ResultsGlobal left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation.ConclusionsMeasuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

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“…3 Typically, functional MR is characterized by dislocation of one or both PMs away from the valvular orifice, with associated tethering of chordae tendineae and leaflets insufficient mobility, function even if the latter is structurally physiological. 18 The most common one is degenerative MR, which is associated to structural alterations MV substructures, usually leaflets and/or chordae tendineae, possibly followed by annular dilation. 2 In particular, the most common mitral disease in western Countries is degenerative mitral valve (DMV) prolapse, whose most frequent distinctive pathologic feature is posterior leaflet prolapse.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation

Sturla

Redaelli

Puppini

et al. 2014

Cardiovasc Eng Tech

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Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edgetoedge repair technique treats mitral regurgitation by suturing the leaflets together and creating a doubleorifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip device. Edgetoedge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edgetoedge technique. Imagebased structural finite element models of three mitral valves affected by posterior prolapse were derived from cinecardiac magnetic resonance imaging. The models accounted for the patientspecific 3D geometry of the valve, including leaflet compound curvature pattern, patientspecific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edgetoedge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that are currently critical for Mitraclip implantation, helping the search for possible solutions.

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Functional Mitral Regurgitation: Current Understanding and Approach to Management

Cited by 17 publications

References 58 publications

Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation

Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation

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