1. Assessment of deformation of the mitral valve complex during off-pump coronary artery bypass surgery using three-dimensional echocardiography in a porcine model 
Takashi Igarashi, MD, PhD, Masumi Iwai-Takano, MD, PhD, FJCC, Hiroki Wakamatsu, MD, PhD, Mineyuki Haruta, PhD, Sadao Omata, PhD, Hitoshi Yokoyama, MD, PhD 
Journal of Cardiology 
DOI: /j.jjcc
Copyright © 2017 Japanese College of Cardiology Terms and Conditions

2. Fig. 1
A schematic overview of the animal preparation, the form of the displacement of the heart and study protocol. (a) A swine was placed in the supine position. Electrocardiogram, respirator, venous injection line, femoral arterial line, and a Swan-Ganz catheter were introduced. (b) The beating heart was positioned in the following four positions in order; the control position, LAD position, RCA position, and LCX position. (c) The echocardiographic and hemodynamic data were acquired in each position. LAD, left anterior descending artery; RCA, right coronary artery; LCX, left circumflex artery.
Journal of Cardiology DOI: ( /j.jjcc )
Copyright © 2017 Japanese College of Cardiology Terms and Conditions

3. Fig. 2
Assessment of the mitral valve. The three-dimensional geometric changes of the mitral valve were assessed by REALVIEW® software. Annular parameters (AP diameter, ML diameter, annular circumference, annular area, and annular height) and tenting parameters (maximum tenting length, mean tenting length, and tenting volume) were measured. AP, anterior–posterior; ML, medial–lateral.
Journal of Cardiology DOI: ( /j.jjcc )
Copyright © 2017 Japanese College of Cardiology Terms and Conditions

4. Fig. 3
The definitions of the three-dimensional coordinates (x, y, and z axis and points) and parameters of the papillary muscle position and leaflet configuration. (a) The three-dimensional coordinates were as follows: A (midpoint of the anterior mitral annulus); B (contralateral point of A on the aortic annulus); C (midpoint of the posterior mitral annulus); APM (the tip of the anterior papillary muscle); and PPM (the tip of the posterior papillary muscle). (b) Tethering distances and APM and PPM angles were defined as the schema. (c) Angle α1, α2, and β were defined according to the schema. APM, anterior papillary muscle; PPM, posterior papillary muscle.
Journal of Cardiology DOI: ( /j.jjcc )
Copyright © 2017 Japanese College of Cardiology Terms and Conditions

5. Fig. 4
Three-dimensional configuration of the mitral valve by REALVIEW®. The tenting of mitral leaflets was increased in the dislocated positions, especially in the LCX position. LCX, left circumflex artery.
Journal of Cardiology DOI: ( /j.jjcc )
Copyright © 2017 Japanese College of Cardiology Terms and Conditions

6. Fig. 5
The correlation between tenting volume and PPM angle, and the schema of the displacement of the papillary muscles in each heart position (short axis view via apex). (a) The PPM angle showed a statistically significant correlation with the tenting volume. (b) This graph revealed the relation between the control position and the LCX position in each case. The tenting volume tended to increase, and the PPM angle tended to decrease following the displacement of the heart in many cases. (c) Three-dimensional coordinates of papillary muscles are shown as follows: x mm, y mm, z mm. The tip of the PPM and the APM dislocated to the medial side with narrowing of the left ventricle in the LCX position. APM, anterior papillary muscle; PPM, posterior papillary muscle; LCX, left circumflex artery.
Journal of Cardiology DOI: ( /j.jjcc )
Copyright © 2017 Japanese College of Cardiology Terms and Conditions