TY - JOUR
T1 - Annular Remodeling in Chronic Ischemic Mitral Regurgitation
T2 - Ring Selection Implications
AU - Tibayan, Frederick A.
AU - Rodriguez, Filiberto
AU - Langer, Frank
AU - Zasio, Mary K.
AU - Bailey, Lynn
AU - Liang, David
AU - Daughters, George T.
AU - Ingels, Neil B.
AU - Miller, D. Craig
AU - Edmunds, Henry
AU - Grossi, Eugene A.
AU - Yuh, David D.
N1 - Funding Information:
The Thoracic Surgery Directors Association (TSDA) Resident Research Award, sponsored by Medtronic, Inc, was established in 1990 to encourage resident research in cardiothoracic surgery. Abstracts submitted to The Society of Thoracic Surgeons (STS) Program Committee representing research performed by residents were forwarded to the TSDA to be considered for this award. The abstracts were reviewed by the TSDA Executive Committee, consisting of Edward D. Verrier, President, Douglas Mathisen, President-Elect, Jeffrey P. Gold, Secretary/Treasurer, and Richard Shemin and John Calhoon, Councillor-at-Large.
Funding Information:
We appreciate the superb technical assistance provided by Carol W. Mead and Maggie Brophy. This work was supported by Grants HL-29589 and HL-67025 from the National Heart, Lung and Blood Institute (NHLBI). Doctors Tibayan, Rodriguez, and Langer are Carl and Leah McConnell Cardiovascular Surgical Research Fellows. Doctor Tibayan was supported by NHLBI Individual Research Service Award HL-67563. Doctor Rodriguez was supported by Grant HL67025–01S1 from the NHLBI and was a recipient of the American College of Surgeons Resident Research Scholarship Award.
PY - 2003/11
Y1 - 2003/11
N2 - Background. More precise understanding of annular remodeling in the evolution of chronic ischemic mitral regurgitation is needed to provide a more rational basis for optimal annuloplasty ring sizing and selection as well as the design of new reparative techniques. Three-dimensional in vivo data describing these geometric perturbations however are lacking. Using an ovine model of chronic myocardial infarction we determined the three-dimensional distortions of the mitral annulus associated with the development of chronic ischemic mitral regurgitation. Methods. Ten sheep underwent placement of radiopaque markers on the left ventricle and mitral annulus as well as placement of snares around the second and third obtuse marginal coronary arteries. After 8 days biplane cinefluoroscopy provided three-dimensional marker data and snare occlusion created an inferior infarction. After 7 more weeks the animals were studied again. Results. Severity of mitral regurgitation increased (0.6 ± 0.5 to 2.5 ± 0.7). Septal-lateral (2.99 ± 0.20 cm to 3.64 ± 0.35 cm, maximum dimension) and commissure-commissure (3.71 ± 0.32 cm to 4.40 ± 0.30 cm) mitral annular diameters and the lengths of the muscular (7.77 ± 0.39 cm to 9.51 ± 0.72 cm) and fibrous annular perimeters (3.36 ± 0.37 cm to 3.85 ± 0.39 cm, p < 0.0001 for all) increased while the height of the annular "saddle horn" above a best-fit plane fell (0.73 ± 0.52 cm to 0.57 ± 0.42 cm, minimum dimension, p = 0.01). Conclusions. These three-dimensional in vivo data reflect annular remodeling in chronic ischemic mitral regurgitation and suggest that mitral repair in this context should be aimed at preventing further lengthening of the intertrigonal distance, reducing the septal-lateral annular diameter to reestablish adequate leaflet coaptation, and restoring the saddle shape of the annulus.
AB - Background. More precise understanding of annular remodeling in the evolution of chronic ischemic mitral regurgitation is needed to provide a more rational basis for optimal annuloplasty ring sizing and selection as well as the design of new reparative techniques. Three-dimensional in vivo data describing these geometric perturbations however are lacking. Using an ovine model of chronic myocardial infarction we determined the three-dimensional distortions of the mitral annulus associated with the development of chronic ischemic mitral regurgitation. Methods. Ten sheep underwent placement of radiopaque markers on the left ventricle and mitral annulus as well as placement of snares around the second and third obtuse marginal coronary arteries. After 8 days biplane cinefluoroscopy provided three-dimensional marker data and snare occlusion created an inferior infarction. After 7 more weeks the animals were studied again. Results. Severity of mitral regurgitation increased (0.6 ± 0.5 to 2.5 ± 0.7). Septal-lateral (2.99 ± 0.20 cm to 3.64 ± 0.35 cm, maximum dimension) and commissure-commissure (3.71 ± 0.32 cm to 4.40 ± 0.30 cm) mitral annular diameters and the lengths of the muscular (7.77 ± 0.39 cm to 9.51 ± 0.72 cm) and fibrous annular perimeters (3.36 ± 0.37 cm to 3.85 ± 0.39 cm, p < 0.0001 for all) increased while the height of the annular "saddle horn" above a best-fit plane fell (0.73 ± 0.52 cm to 0.57 ± 0.42 cm, minimum dimension, p = 0.01). Conclusions. These three-dimensional in vivo data reflect annular remodeling in chronic ischemic mitral regurgitation and suggest that mitral repair in this context should be aimed at preventing further lengthening of the intertrigonal distance, reducing the septal-lateral annular diameter to reestablish adequate leaflet coaptation, and restoring the saddle shape of the annulus.
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U2 - 10.1016/S0003-4975(03)00880-4
DO - 10.1016/S0003-4975(03)00880-4
M3 - Article
C2 - 14602284
AN - SCOPUS:0242552182
SN - 0003-4975
VL - 76
SP - 1549
EP - 1555
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -