Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy Mehul R. Bhatt, MD,

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Presentation transcript:

Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy Mehul R. Bhatt, MD, Carlos E. Alfonso, MD, Amar M. Bhatt, BS, Sangmin Lee, MD, Alexandre C. Ferreira, MD, Tomas A. Salerno, MD, Eduardo de Marchena, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 5, Pages 1123-1128 (November 2009) DOI: 10.1016/j.jtcvs.2008.10.056 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Measurement of mitral annular diameter and mitral valve coaptation depth was done in the 4-chamber apical views during midsystole. A, Mitral annular diameter was defined as the distance between the hinge points of the anterior and posterior mitral valve leaflets. B, Coaptation depth was measured as the length from the mitral annular plane to the point at which the mitral leaflets touch during systole. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1123-1128DOI: (10.1016/j.jtcvs.2008.10.056) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Panel A shows the 4-chamber apical echocardiogram of a 46-year-old hypertensive man with nonischemic cardiomyopathy and a left ventricular ejection fraction of 20%, demonstrating a large transverse midcavity false tendon from the septum to the lateral wall (arrow). The mitral annular diameter and coaptation depth were measured at 3.8 cm and 0.9 cm, respectively. Panel B shows a Doppler echocardiogram across the mitral valve demonstrating only mild mitral insufficiency. In contrast, panel C demonstrates the apical 4-chamber echocardiographic view for a 61-year-old woman with type 2 diabetes and ischemic cardiomyopathy with a dilated left ventricle measured at 8 cm, an estimated left ventricular ejection fraction of 20%, and no false tendon with a measured mitral annular diameter and coaptation depth of 4.5 cm and 1.8 cm, respectively. Panel D shows severe mitral regurgitation by means of Doppler echocardiographic analysis, with evidence of pulmonary vein reversal and a regurgitant jet filling more than 20% of the left atrium. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1123-1128DOI: (10.1016/j.jtcvs.2008.10.056) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Incidence of severe mitral regurgitation (MR) according to the presence or absence of a false tendon and the cause of cardiomyopathy. Overall, patients with false tendons and a cardiomyopathy had a significantly lower percentage of severe mitral regurgitation compared with control subjects. EF, Ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1123-1128DOI: (10.1016/j.jtcvs.2008.10.056) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions