TY - JOUR
T1 - Relocation of papillary muscles for ischemic mitral valve regurgitation: The role of three-dimensional transesophageal Echocardiography
AU - Fattouch, Khalil
AU - Guccione, Francesco
AU - Dioguardi, Pietro
AU - Castrovinci, Sebastiano
AU - Murana, Giacomo
AU - Nasso, Giuseppe
AU - Fattouch, Khalil
AU - Speziale, Giuseppe
AU - Bianco, Giuseppe
PY - 2014
Y1 - 2014
N2 - OBJECTIVE: The assessment of the mitral valve apparatus (MVA) and its modifications during ischemic mitral regurgitation (IMR) is better performed by three-dimensional (3D) transesophageal echocardiography (TEE). The aim of our study was to carry out nonrestrictive mitral annuloplasty in addition to relocation of papillary muscles (PPMs) oriented by preoperative real-time 3D TEE through the mitral valve quantification dedicated software. METHODS: Since January 2008, a total of 70 patients with severe IMR were examined both before and after mitral valve repair. The mean (SD) coaptation depth and the mean (SD) tenting area were 1.4 (0.4) cm and 3.2 (0.5) cm, respectively. Intraoperative 3D TEE was performed, followed by a 3D offline reconstruction of the MVA. A schematic MVA model was obtained, and a geometric model as a "truncated cone" was traced according to preoperative data. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth of approximately 6 mm was used to detect the new position of the PPMs tips. RESULTS: Perioperative offline reconstruction of the MVA and the respective truncated cone was feasible in all patients. The expected position of the PPMs tips, desirable to reach a normal tenting area with a coaptation depth of 6 mm or more, was obtained in all patients. After surgery, all parameters were calculated, and no statistically significant difference was found compared with the expected data. CONCLUSIONS: Relocation of PPMs plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results in patients with severe IMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction. © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery.
AB - OBJECTIVE: The assessment of the mitral valve apparatus (MVA) and its modifications during ischemic mitral regurgitation (IMR) is better performed by three-dimensional (3D) transesophageal echocardiography (TEE). The aim of our study was to carry out nonrestrictive mitral annuloplasty in addition to relocation of papillary muscles (PPMs) oriented by preoperative real-time 3D TEE through the mitral valve quantification dedicated software. METHODS: Since January 2008, a total of 70 patients with severe IMR were examined both before and after mitral valve repair. The mean (SD) coaptation depth and the mean (SD) tenting area were 1.4 (0.4) cm and 3.2 (0.5) cm, respectively. Intraoperative 3D TEE was performed, followed by a 3D offline reconstruction of the MVA. A schematic MVA model was obtained, and a geometric model as a "truncated cone" was traced according to preoperative data. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth of approximately 6 mm was used to detect the new position of the PPMs tips. RESULTS: Perioperative offline reconstruction of the MVA and the respective truncated cone was feasible in all patients. The expected position of the PPMs tips, desirable to reach a normal tenting area with a coaptation depth of 6 mm or more, was obtained in all patients. After surgery, all parameters were calculated, and no statistically significant difference was found compared with the expected data. CONCLUSIONS: Relocation of PPMs plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results in patients with severe IMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction. © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery.
KW - Ischemic mitral valve regurgitation; Mitral valve repair; Three-dimensional echocardiography; Aged; Echocardiography
KW - Three-Dimensional; Cardiology and Cardiovascular Medicine; Surgery
KW - Transesophageal; Feasibility Studies; Female; Humans; Intraoperative Period; Male; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Myocardial Ischemia; Papillary Muscles; Retrospective Studies; Treatment Outcome; Echocardiography
KW - Ischemic mitral valve regurgitation; Mitral valve repair; Three-dimensional echocardiography; Aged; Echocardiography
KW - Three-Dimensional; Cardiology and Cardiovascular Medicine; Surgery
KW - Transesophageal; Feasibility Studies; Female; Humans; Intraoperative Period; Male; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Myocardial Ischemia; Papillary Muscles; Retrospective Studies; Treatment Outcome; Echocardiography
UR - http://hdl.handle.net/10447/212093
M3 - Article
VL - 9
SP - 54
EP - 59
JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
SN - 1556-9845
ER -