Ablation of mitral annular and leaflet muscle: Effects on annular and leaflet dynamics

Mitral annular (MA) and leaflet three-dimensional (3-D) dynamics were examined after circumferential phenol ablation of the MA and anterior mitral leaflet (AML) muscle. Radiopaque markers were sutured to the left ventricle, MA, and both mitral leaflets in 18 sheep. In 10 sheep, phenol was applied circumferentially to the atrial surface of the mitral annulus and the hinge region of the AML, whereas 8 sheep served as controls. Animals were studied with biplane video fluoroscopy for computation of 3-D mitral annular area (MAA) and leaflet shape. MAA contraction (MAA_Cont) was determined from maximum to minimum value. Presystolic MAA (PS-MAA_Cont) reduction was calculated as the percentage of total reduction occurring before end diastole. Phenol ablation decreased PS-MAA_Cont (72 ± 6 vs. 47 ± 31%, P = 0.04) and delayed valve closure (31 ± 11 vs. 57 ± 25 ms, P = 0.017). In control, the AML had a compound sigmoid shape; after phenol, this shape was entirely concave to the atrium during valve closure. These data indicate that myocardial fibers on the atrial side of the valve influence the 3-D dynamic geometry and shape of the MA and AML.