Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

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Presentation transcript:

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty Muralidhar Padala, MS, Scott N. Powell, BS, Laura R. Croft, BS, Vinod H. Thourani, MD, Ajit P. Yoganathan, PhD, David H. Adams, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 2, Pages 309-315 (August 2009) DOI: 10.1016/j.jtcvs.2009.01.031 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Schematic of the in vitro left heart simulator with a native porcine mitral valve. B, Atrial view of the mitral valve showing the anterior and the posterior leaflets. C, Ventricular view of the valve showing the chordae tendineae and the papillary muscles. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 309-315DOI: (10.1016/j.jtcvs.2009.01.031) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, The top left image is a 2-dimensional echocardiograph that shows the prolapsing P2 scallop of the posterior leaflet resulting from chordal transection, and the bottom left image is a 3-dimensional reconstruction of the prolapsing leaflet as seen from the left atrium. The 3-dimensional reconstruction clearly shows the leaflet prolapse and the loss of leaflet coaptation. B, The 3-dimensional eccentric regurgitation jet recorded by 3-dimensional echocardiography from the top view and isometric views. A regurgitation jet directed toward the anterior annulus can be clearly seen with the posterior leaflet prolapse. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 309-315DOI: (10.1016/j.jtcvs.2009.01.031) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Sequential steps to replace the ruptured posterior chordae tendineae with loops of 5-0 ePTFE sutures. B, Sequential steps to perform triangular resection and approximation of the resected region. C, Protocol to perform quadrangular resection and annular plication with a compression stitch. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 309-315DOI: (10.1016/j.jtcvs.2009.01.031) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Variation in regurgitation volume per heart beat for the control, prolapse, and the three repair procedures. B, Variation in peak systolic leaflet coaptation length between the different experimental conditions. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 309-315DOI: (10.1016/j.jtcvs.2009.01.031) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Geometric endpoints measured from 2-dimensional echocardiographs to quantify leaflet mobility. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 309-315DOI: (10.1016/j.jtcvs.2009.01.031) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions