Original articleCardiovascularMitral Valve Tenting Index for Assessment of Subvalvular Remodeling
Section snippets
Surgical Protocol
The study protocol was reviewed and approved by the University of Pennsylvania School of Medicine Institutional Animal Care and Use Committee (IACUC) and was in compliance with guidelines for humane care (National Institutes of Health Publication No. 85-23, revised 1996).
Ten sheep were pretreated with buprenorphine (2 μg/kg) and then induced with intravenous (IV) sodium thiopental (10 to 15 mg/kg), intubated, and anesthetized with isoflurane (1.5% to 2.0%) and oxygen (Narkomed, North American
Results
To ensure that mitral leaflet loading conditions, which influence annular geometry [17], were similar at each data acquisition point, statistical comparisons were performed for all hemodynamic indicators at each data acquisition point and are summarized in Table 1. No statistically significant differences were found between time points for any indicator; therefore, leaflet loading conditions were likely similar at all data acquisition points. None of the animals had significant MR at baseline.
Comment
More than 5 million Americans have heart failure, up to 40% of these patients exhibit some degree of MR, and in 300,000 the MR is severe [18]. The negative impact of IMR on survival has been well documented, and a graded relationship between the severity of MR and mortality has been repeatedly demonstrated [18, 19].
During the past decade, an increasingly aggressive surgical approach to IMR has developed. Mitral ring annuloplasty, with or without coronary revascularization, has become the
Acknowledgment
This research was supported by National Institutes of Health grants HL63954 (RCG), HL73021 and HL76560 (JHG) and by American Heart Association Post-Doctoral Fellowship 0625455U (LPR).
References (30)
- et al.
Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction
Am J Cardiol
(2000) - et al.
Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model
Ann Thorac Surg
(2003) - et al.
Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications
Ann Thorac Surg
(2003) - et al.
Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation
J Am Coll Cardiol
(2001) - et al.
Ischemic mitral regurgitation: impact of the left ventricle and mitral valve in patients with left ventricular systolic dysfunction
Ann Thorac Surg
(2005) - et al.
Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography
J Am Soc Echo
(2006) - et al.
Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography
J Am Coll Cardiol
(2005) - et al.
Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique
J Am Coll Cardiol
(1986) - et al.
The dynamic anterior mitral annulus
Ann Thorac Surg
(2004) - et al.
Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure
Am J Cardiol
(2003)
Comparative morbidity of mitral valve repair versus replacement for mitral regurgitation with and without coronary artery disease
Ann Thorac Surg
Mitral valve surgery in the patient with left ventricular dysfunction
Semin Thorac Cardiovasc Surg
Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation
J Thorac Cardiovasc Surg
Mitral valve surgery for CHF: a failed innovation?
Semin Thorac Cardiovasc Surg
The effect of regional ischemia on mitral valve annular saddle shape
Ann Thorac Surg
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2021, Journal of the American Society of EchocardiographyCitation Excerpt :2) Leaflet size was measured by ML(area) as exposed total mitral leaflet (ML) area, AML(area) as total AML area including coapting leaflet area, PML(area) as total PML area, PML/AML(area) as the ratio of PML(area) to AML(area), PML/ML(area) as the ratio of PML(area) to ML(area), and AML/ML(area) as the ratio of AML(area) to ML(area). ( 3) Degree of tenting was determined by tenting(vol) as ML tenting volume, tenting index as the ratio of total ML area (ML(area)) to mitral annular area (annulus(area))—this index being similarly used in earlier studies27—and angle(APML) as the anterior to posterior ML angle. ( 4) Degree of prolapse was measured by prolapse(vol) as the volume of ML prolapse.
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