Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation

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Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation Khalil Fattouch, MD, PhD, Giacomo Murana, MD, Sebastiano Castrovinci, MD, Claudia Mossuto, MD, Roberta Sampognaro, MD, Maria Giuliana Borruso, MD, Emanuela Clara Bertolino, MD, Giuseppa Caccamo, MD, Giovanni Ruvolo, MD, Patrizio Lancellotti, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 4, Pages S38-S42 (April 2012) DOI: 10.1016/j.jtcvs.2012.01.010 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Mitral valve annulus diameters and distance between the tip of PPM and the ipsilateral annulus were measured on multislice systodiastolic views of the mitral valve apparatus and offline reconstruction by MQV software. B, The shape of the annulus and leaflets was traced. AL, Anterolateral; PM, posteromedial; Ao, aorta; SL, septolateral; AML, anterior mitral leaflet; PML, posterior mitral leaflet; APM, anterior papillary muscle; PPM, posterior papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 2012 143, S38-S42DOI: (10.1016/j.jtcvs.2012.01.010) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic mitral valve apparatus model and the respective truncated cone were traced. AL, Anterolateral; PM, posteromedial; Ao, aorta; 3D, 3-dimensional. The Journal of Thoracic and Cardiovascular Surgery 2012 143, S38-S42DOI: (10.1016/j.jtcvs.2012.01.010) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Surface of the leaflets and angle between the leaflets and the mitral annulus were calculated. AL, Anterolateral; PM, posteromedial; Ao, aorta. The Journal of Thoracic and Cardiovascular Surgery 2012 143, S38-S42DOI: (10.1016/j.jtcvs.2012.01.010) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Expected truncated cone was retraced according to the diameters of the selected ring despite the normal annular diameter; expected normal coaptation depth was used to obtain the expected position of the papillary muscle (PPM) tips. The Journal of Thoracic and Cardiovascular Surgery 2012 143, S38-S42DOI: (10.1016/j.jtcvs.2012.01.010) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Postrepair parameter measurements. AL, Anterolateral; PM, posteromedial; Ao, aorta; A, anterior; P, posterior. The Journal of Thoracic and Cardiovascular Surgery 2012 143, S38-S42DOI: (10.1016/j.jtcvs.2012.01.010) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions