Importance of Mitral Valve Second-Order Chordae for Left Ventricular Geometry, Wall Thickening Mechanics, and Global Systolic Function

Rodriguez, Filiberto; Langer, Frank; Harrington, Katherine; Tibayan, Frederick A.; Zasio, Mary K.; Cheng, Allen; Liang, David; Daughters, George T.; Covell, James W.; Criscione, John C.; Ingels, Neil B.; Miller, D. Craig

doi:10.1161/01.cir.0000138580.57971.b4

Cited by 76 publications

(60 citation statements)

References 40 publications

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“…The MCT link the free edges and the ventricular surface of both leaflets of the MV to the papillary muscles, thus preventing the backflow of the blood into the left atrium during ventricular contraction. Several equivalent classifications for the MCT are proposed in the literature [13,29,12,26,27,3,20,31,24]. In general, the MCTs are classified according to their insertion sites on the mitral leaflets.…”

Section: The Mitral Valve and The Mitral Chordae Tendineaementioning

confidence: 99%

Determination of the mechanical properties of normal and calcified human mitral chordae tendineae

Casado

Diego

Ferreño

et al. 2012

Journal of the Mechanical Behavior of Biomedical Materials

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The aim of the present research is to determine the influence of the calcification of human mitral valves on the mechanical properties of their marginal chordae tendineae. The study was performed on marginal chords obtained from thirteen human mitral valves, explanted at surgery, including six non-calcified, four moderately calcified and three strongly calcified valves. The mechanical response of the chords from the non-calcified and moderately calcified valves was determined by means of quasi-static tensile tests (the poor condition of the strongly calcified valves prevented them from being mechanically characterised). The material parameters that were obtained and analysed (the Young's modulus, the secant modulus, the proportional limit stress, the ultimate strength, the strain at fracture and the density of energy stored up to maximum load) revealed noticeable differences in mechanical behaviour between the two groups of mitral chordae tendineae. Large scatter was obtained in all cases, nevertheless, considering the mean values, it was observed that the normal chords are between three and seven times stiffer or more resistant than the moderately calcified ones. On the contrary, the results obtained for the strain at fracture showed a rather different picture as, in this case, no significant differences were observed between the two families of chords. A scanning electron microscopy study was conducted in order to find out the relevant features of the calcium deposits present in the calcified chordae tendineae. In addition, the general aspects appreciated in the stress vs. strain curves were correlated with the collagen morphological evidences determined microscopically. Finally, the calcium content present in the three groups of chords was quantitatively determined through atomic absorption spectroscopy; then, the relation between the mechanical properties of normal and moderately calcified chords as a function of its calcium content was obtained. This analysis confirmed the existence of a strong correlation between calcium content and stiffness or resistance whereas the influence on the ductility seems to be negligible.

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Section: The Mitral Valve and The Mitral Chordae Tendineaementioning

confidence: 99%

Determination of the mechanical properties of normal and calcified human mitral chordae tendineae

Casado

Diego

Ferreño

et al. 2012

Journal of the Mechanical Behavior of Biomedical Materials

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“…It is most efficacious in apically displaced symmetric MV tethering, as seen with anterior myocardial infarction (33). However, controversy does exist regarding possible untoward long-term effects on MV and LV function with chordal release, given the importance of the secondary order chords in maintaining the closing-tethering forth balance of the MV apparatus, and supporting LV geometry (34,35).…”

Section: Discussionmentioning

confidence: 99%

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mihos¹,

Xydas²,

Yucel³

et al. 2017

J. Thorac. Dis.

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Background: Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined.Methods: A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. Conclusions: When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.

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“…Strut chords are under constant tension and help maintain size and shape of the left ventricle. Transection of strut chords results in alterations in left ventricular geometry and can lead to left ventricular remodeling (11).…”

Section: Anatomy Of the Mitral Valve Structuresmentioning

confidence: 99%

Peri-procedural imaging for transcatheter mitral valve replacement

Natarajan¹,

Patel

Bartel³

et al. 2016

Cardiovasc. Diagn. Ther.

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Importance of Mitral Valve Second-Order Chordae for Left Ventricular Geometry, Wall Thickening Mechanics, and Global Systolic Function

Cited by 76 publications

References 40 publications

Determination of the mechanical properties of normal and calcified human mitral chordae tendineae

Determination of the mechanical properties of normal and calcified human mitral chordae tendineae

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Peri-procedural imaging for transcatheter mitral valve replacement

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