TY - JOUR
T1 - Effect of cutting second-order chordae on in-vivo anterior mitral leaflet compound curvature
AU - Rodriguez, Filiberto
AU - Langer, Frank
AU - Harrington, Katherine B.
AU - Tibayan, Frederick A.
AU - Zasio, Mary K.
AU - Liang, David
AU - Daughters, George T.
AU - Ingels, Neil B.
AU - Miller, D. Craig
PY - 2005/9
Y1 - 2005/9
N2 - Background and aim of the study: Leaflet curvature determines leaflet stress. In order to assess the influence of second-order chordae (2°CT) on anterior mitral valve leaflet (AMVL) geometry, AMVL curvature was measured before (Baseline) and after (CUT) cutting the 2°CT. Methods: Miniature radiopaque markers were sutured onto the AMVL in eight sheep: four along the central-meridian from mid-septal annulus to the free-margin; and one each at the 2°CT insertion. Biplane videofluoroscopic data were acquired (open-chest) before and after CUT. Marker-triplet 3-D coordinates were used to calculate radii-of-curvature at LVPmax along the central-meridian (ROCm) and across the AMVL belly (commissure-commissure axis, ROCc-c). Results: CUT did not change LVPmax (111 ± 12 versus 106 ± 11 mmHg; p = 0.19). At baseline, the AMVL central-meridian had compound curvature: Convex to the left ventricle near the annulus (-ROCm) and concave near the free-margin (+ROCm). After CUT, the AMVL flattened: ROCm increased near the annulus (from -1.37 ± 0.52 to -12.58 ± 29.04 cm; p = 0.02), but did not change near the edge. In the commissure-commissure axis, ROCc-c was concave to the left ventricle at baseline and increased after CUT in all eight animals. In five sheep, ROCc-c was increased (from 1.93 ± 1.01 to 2.80 ± 1.36 cm; p = 0.03), but in three sheep ROCc-c was increased and inverted (from 3.65 ± 2.17 to -1.72: ± 0.53 cm; p = 0.03), becoming convex to the left ventricle. Conclusion: Compound curvature along the AMVL central-meridian appears to be an intrinsic leaflet property that persists even without support from second-order chordae, whereas concave curvature in the commissure-commissure axis is more dependent on intact second-order chordae. Leaflet compound curvature must be incorporated into future finite element models to characterize leaflet stresses accurately. The importance of second-order chordae in maintaining leaflet shape must be considered during mitral repair. A larger ROC increases leaflet stresses, while reversal of ROC changes tensile stress to compressive stress; this might trigger deleterious leaflet remodeling after chordal cutting.
AB - Background and aim of the study: Leaflet curvature determines leaflet stress. In order to assess the influence of second-order chordae (2°CT) on anterior mitral valve leaflet (AMVL) geometry, AMVL curvature was measured before (Baseline) and after (CUT) cutting the 2°CT. Methods: Miniature radiopaque markers were sutured onto the AMVL in eight sheep: four along the central-meridian from mid-septal annulus to the free-margin; and one each at the 2°CT insertion. Biplane videofluoroscopic data were acquired (open-chest) before and after CUT. Marker-triplet 3-D coordinates were used to calculate radii-of-curvature at LVPmax along the central-meridian (ROCm) and across the AMVL belly (commissure-commissure axis, ROCc-c). Results: CUT did not change LVPmax (111 ± 12 versus 106 ± 11 mmHg; p = 0.19). At baseline, the AMVL central-meridian had compound curvature: Convex to the left ventricle near the annulus (-ROCm) and concave near the free-margin (+ROCm). After CUT, the AMVL flattened: ROCm increased near the annulus (from -1.37 ± 0.52 to -12.58 ± 29.04 cm; p = 0.02), but did not change near the edge. In the commissure-commissure axis, ROCc-c was concave to the left ventricle at baseline and increased after CUT in all eight animals. In five sheep, ROCc-c was increased (from 1.93 ± 1.01 to 2.80 ± 1.36 cm; p = 0.03), but in three sheep ROCc-c was increased and inverted (from 3.65 ± 2.17 to -1.72: ± 0.53 cm; p = 0.03), becoming convex to the left ventricle. Conclusion: Compound curvature along the AMVL central-meridian appears to be an intrinsic leaflet property that persists even without support from second-order chordae, whereas concave curvature in the commissure-commissure axis is more dependent on intact second-order chordae. Leaflet compound curvature must be incorporated into future finite element models to characterize leaflet stresses accurately. The importance of second-order chordae in maintaining leaflet shape must be considered during mitral repair. A larger ROC increases leaflet stresses, while reversal of ROC changes tensile stress to compressive stress; this might trigger deleterious leaflet remodeling after chordal cutting.
UR - http://www.scopus.com/inward/record.url?scp=27744609241&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27744609241&partnerID=8YFLogxK
M3 - Article
C2 - 16245497
AN - SCOPUS:27744609241
SN - 0966-8519
VL - 14
SP - 592
EP - 602
JO - Journal of Heart Valve Disease
JF - Journal of Heart Valve Disease
IS - 5
ER -