Imbalanced chordal force distribution causes acute ischemic mitral regurgitation: Mechanistic insights from chordae tendineae force measurements in pigs

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Imbalanced chordal force distribution causes acute ischemic mitral regurgitation: Mechanistic insights from chordae tendineae force measurements in pigs Sten Lyager Nielsen, MD, PhD, Søren B. Hansen, MD, PhD, Katrine O. Nielsen, MD, Hans Nygaard, DMSc, Peter K. Paulsen, MD, DMSc, J. Michael Hasenkam, MD, DMSc The Journal of Thoracic and Cardiovascular Surgery Volume 129, Issue 3, Pages 525-531 (March 2005) DOI: 10.1016/j.jtcvs.2004.07.044 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Time course of the chordae tendineae forces in relation to the LV and left atrial (LA) pressure at control (left) and during acute ischemic mitral regurgitation (right) from 1 animal. Data are aligned at end-diastole (time 0). APM-AL, APM-PL, PPM-AL, and PPM-PL, chordae from the anterolateral (APM) and posteromedial (PPM) papillary muscle to the anterior (AL) and posterior (PL) mitral leaflet; MR, mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 525-531DOI: (10.1016/j.jtcvs.2004.07.044) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Mitral leaflet coaptation geometry during acute ischemic mitral regurgitation from the apical view (top) and the sagittal views toward the posteromedial commissure (PC) (bottom left) and the anterolateral commissure (AC) (bottom right). Redistribution of the chordae tendineae forces during ischemia resulted in relative leaflet prolapse at the PC and leaflet tethering at the AC. AL and PL, Anterior and posterior mitral valve leaflet; Ao, aorta; PPM, posteromedial papillary muscle; APM, anterolateral papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 525-531DOI: (10.1016/j.jtcvs.2004.07.044) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions