Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation

Frederick (Fred) Tibayan, Filiberto Rodriguez, Mary K. Zasio, Lynn Bailey, David Liang, George T. Daughters, Frank Langer, Neil B. Ingels, D. Craig Miller

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

Background - Better understanding of the precise 3-dimensional geometric changes of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation (CIMR) is needed in order to devise better surgical repair techniques. We hypothesized that changes after inferior myocardial infarction would be different in hearts that developed CIMR compared with those that did not. Methods and Results - Twenty-four sheep underwent coronary snare and marker placement (annulus, papillary muscles, and anterior and posterior leaflets). After 8 days, cinefluoroscopy provided 3-dimensional marker data, and snare occlusion of obtuse marginal branches created inferior myocardial infarction, including the posterior papillary muscle. After 7 weeks, the 16 surviving animals were studied again and grouped by mitral regurgitation grade (≥ 2+, n=10 versus ≤ 1 +, n=6). End-systolic mitral annulus dimensions, components of papillary muscle and leaflet displacement, were calculated. After inferior myocardial infarction, total displacement of the posterior papillary muscle from the midseptal annulus ("saddle horn") was greater in CIMR(+) animals: 6.5±3.2 versus 3.1±2.7 (P=0.02), with the posterior papillary muscle moving more laterally (6.8±3.4 versus 2.5±3.5 mm, P=0.01). Increase in mitral annular septal-lateral diameter was greater in animals with CIMR (4.9±2.7 versus 2.3±2.0, P=0.02), and apical displacement of the posterior leaflet (PL) margin was also greater in the CIMR(+) group (1.7±1.0 versus 0.3±0.5, P=0.01). Conclusions - The CIMR(+) group had greater septal-lateral annular dilatation, lateral posterior papillary muscle displacement, and apical PL restriction, indicating that these associated geometric alterations may be important in the pathogenesis of CIMR. Treatment of CIMR should address both annular septal-lateral dilatation and lateral displacement of the posterior papillary muscle.

Original languageEnglish (US)
JournalCirculation
Volume108
Issue number10 SUPPL.
StatePublished - Sep 9 2003
Externally publishedYes

Fingerprint

Mitral Valve Insufficiency
Papillary Muscles
Inferior Wall Myocardial Infarction
Dilatation
Horns
Sheep

Keywords

  • Ischemic heart disease
  • Ischemic mitral regurgitation
  • Mitral annuloplasty
  • Mitral regurgitation
  • Mitral valve repair
  • Myocardial ischemia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Tibayan, F. F., Rodriguez, F., Zasio, M. K., Bailey, L., Liang, D., Daughters, G. T., ... Miller, D. C. (2003). Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation, 108(10 SUPPL.).

Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. / Tibayan, Frederick (Fred); Rodriguez, Filiberto; Zasio, Mary K.; Bailey, Lynn; Liang, David; Daughters, George T.; Langer, Frank; Ingels, Neil B.; Miller, D. Craig.

In: Circulation, Vol. 108, No. 10 SUPPL., 09.09.2003.

Research output: Contribution to journalArticle

Tibayan, FF, Rodriguez, F, Zasio, MK, Bailey, L, Liang, D, Daughters, GT, Langer, F, Ingels, NB & Miller, DC 2003, 'Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation', Circulation, vol. 108, no. 10 SUPPL..
Tibayan FF, Rodriguez F, Zasio MK, Bailey L, Liang D, Daughters GT et al. Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation. 2003 Sep 9;108(10 SUPPL.).
Tibayan, Frederick (Fred) ; Rodriguez, Filiberto ; Zasio, Mary K. ; Bailey, Lynn ; Liang, David ; Daughters, George T. ; Langer, Frank ; Ingels, Neil B. ; Miller, D. Craig. / Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. In: Circulation. 2003 ; Vol. 108, No. 10 SUPPL.
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abstract = "Background - Better understanding of the precise 3-dimensional geometric changes of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation (CIMR) is needed in order to devise better surgical repair techniques. We hypothesized that changes after inferior myocardial infarction would be different in hearts that developed CIMR compared with those that did not. Methods and Results - Twenty-four sheep underwent coronary snare and marker placement (annulus, papillary muscles, and anterior and posterior leaflets). After 8 days, cinefluoroscopy provided 3-dimensional marker data, and snare occlusion of obtuse marginal branches created inferior myocardial infarction, including the posterior papillary muscle. After 7 weeks, the 16 surviving animals were studied again and grouped by mitral regurgitation grade (≥ 2+, n=10 versus ≤ 1 +, n=6). End-systolic mitral annulus dimensions, components of papillary muscle and leaflet displacement, were calculated. After inferior myocardial infarction, total displacement of the posterior papillary muscle from the midseptal annulus ({"}saddle horn{"}) was greater in CIMR(+) animals: 6.5±3.2 versus 3.1±2.7 (P=0.02), with the posterior papillary muscle moving more laterally (6.8±3.4 versus 2.5±3.5 mm, P=0.01). Increase in mitral annular septal-lateral diameter was greater in animals with CIMR (4.9±2.7 versus 2.3±2.0, P=0.02), and apical displacement of the posterior leaflet (PL) margin was also greater in the CIMR(+) group (1.7±1.0 versus 0.3±0.5, P=0.01). Conclusions - The CIMR(+) group had greater septal-lateral annular dilatation, lateral posterior papillary muscle displacement, and apical PL restriction, indicating that these associated geometric alterations may be important in the pathogenesis of CIMR. Treatment of CIMR should address both annular septal-lateral dilatation and lateral displacement of the posterior papillary muscle.",
keywords = "Ischemic heart disease, Ischemic mitral regurgitation, Mitral annuloplasty, Mitral regurgitation, Mitral valve repair, Myocardial ischemia",
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T1 - Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation

AU - Tibayan, Frederick (Fred)

AU - Rodriguez, Filiberto

AU - Zasio, Mary K.

AU - Bailey, Lynn

AU - Liang, David

AU - Daughters, George T.

AU - Langer, Frank

AU - Ingels, Neil B.

AU - Miller, D. Craig

PY - 2003/9/9

Y1 - 2003/9/9

N2 - Background - Better understanding of the precise 3-dimensional geometric changes of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation (CIMR) is needed in order to devise better surgical repair techniques. We hypothesized that changes after inferior myocardial infarction would be different in hearts that developed CIMR compared with those that did not. Methods and Results - Twenty-four sheep underwent coronary snare and marker placement (annulus, papillary muscles, and anterior and posterior leaflets). After 8 days, cinefluoroscopy provided 3-dimensional marker data, and snare occlusion of obtuse marginal branches created inferior myocardial infarction, including the posterior papillary muscle. After 7 weeks, the 16 surviving animals were studied again and grouped by mitral regurgitation grade (≥ 2+, n=10 versus ≤ 1 +, n=6). End-systolic mitral annulus dimensions, components of papillary muscle and leaflet displacement, were calculated. After inferior myocardial infarction, total displacement of the posterior papillary muscle from the midseptal annulus ("saddle horn") was greater in CIMR(+) animals: 6.5±3.2 versus 3.1±2.7 (P=0.02), with the posterior papillary muscle moving more laterally (6.8±3.4 versus 2.5±3.5 mm, P=0.01). Increase in mitral annular septal-lateral diameter was greater in animals with CIMR (4.9±2.7 versus 2.3±2.0, P=0.02), and apical displacement of the posterior leaflet (PL) margin was also greater in the CIMR(+) group (1.7±1.0 versus 0.3±0.5, P=0.01). Conclusions - The CIMR(+) group had greater septal-lateral annular dilatation, lateral posterior papillary muscle displacement, and apical PL restriction, indicating that these associated geometric alterations may be important in the pathogenesis of CIMR. Treatment of CIMR should address both annular septal-lateral dilatation and lateral displacement of the posterior papillary muscle.

AB - Background - Better understanding of the precise 3-dimensional geometric changes of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation (CIMR) is needed in order to devise better surgical repair techniques. We hypothesized that changes after inferior myocardial infarction would be different in hearts that developed CIMR compared with those that did not. Methods and Results - Twenty-four sheep underwent coronary snare and marker placement (annulus, papillary muscles, and anterior and posterior leaflets). After 8 days, cinefluoroscopy provided 3-dimensional marker data, and snare occlusion of obtuse marginal branches created inferior myocardial infarction, including the posterior papillary muscle. After 7 weeks, the 16 surviving animals were studied again and grouped by mitral regurgitation grade (≥ 2+, n=10 versus ≤ 1 +, n=6). End-systolic mitral annulus dimensions, components of papillary muscle and leaflet displacement, were calculated. After inferior myocardial infarction, total displacement of the posterior papillary muscle from the midseptal annulus ("saddle horn") was greater in CIMR(+) animals: 6.5±3.2 versus 3.1±2.7 (P=0.02), with the posterior papillary muscle moving more laterally (6.8±3.4 versus 2.5±3.5 mm, P=0.01). Increase in mitral annular septal-lateral diameter was greater in animals with CIMR (4.9±2.7 versus 2.3±2.0, P=0.02), and apical displacement of the posterior leaflet (PL) margin was also greater in the CIMR(+) group (1.7±1.0 versus 0.3±0.5, P=0.01). Conclusions - The CIMR(+) group had greater septal-lateral annular dilatation, lateral posterior papillary muscle displacement, and apical PL restriction, indicating that these associated geometric alterations may be important in the pathogenesis of CIMR. Treatment of CIMR should address both annular septal-lateral dilatation and lateral displacement of the posterior papillary muscle.

KW - Ischemic heart disease

KW - Ischemic mitral regurgitation

KW - Mitral annuloplasty

KW - Mitral regurgitation

KW - Mitral valve repair

KW - Myocardial ischemia

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