What question did this study set out to answer?

To determine whether selectively cutting critically positioned basal chordae can reduce ischemic mitral regurgitation caused by leaflet tethering without inducing leaflet prolapse.

October 16, 2001Circulation

Chordal Cutting

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Why the study?

Does cutting a limited number of basal chordae reduce ischemic mitral regurgitation in animal models with papillary muscle displacement?

Population

8 mitral valves: 1 porcine in vitro pilot with papillary muscle displacement and 7 sheep with acute…

Comparison

Cutting the 2 central basal chordae vs Pre-intervention state

Design

Preclinical

Authors

EMEmmanuel MessasVascular / Pulmonary Vascular JGJorge GuerreroArkansas Children's Hospital MHMark D. HandschumacherCardiac Imaging

Discussion

Member takes

Implication

Provides proof-of-concept that basal chordal cutting improves leaflet coaptation in ischemic.

Key Points

To determine whether selectively cutting critically positioned basal chordae can reduce ischemic mitral regurgitation caused by leaflet tethering without inducing leaflet prolapse.
Evaluated 8 mitral valves across two preparations: 1 in vitro porcine model with papillary muscle displacement and 7 in vivo sheep with acute inferobasal myocardial infarction.
Quantified mitral regurgitation and valve geometry using three-dimensional echocardiography before and after transecting the two central basal chordae.
Severing the two central basal chordae successfully restored leaflet coaptation and eliminated anterior leaflet angulation without producing prolapse in all 8 valves.
In vivo mitral regurgitation increased from 0.8±0.2 to 7.1±0.5 mL/beat after infarction and dropped to 0.9±0.1 mL/beat following chordal cutting (P < 0.0001).
Reductions in regurgitant volume strongly correlated with changes in three-dimensional leaflet surface area required to bridge the orifice (r² = 0.76).

Structured PICO

Does cutting a limited number of basal chordae reduce ischemic mitral regurgitation in animal models with papillary muscle displacement?

Population

8 mitral valves: 1 porcine in vitro pilot with papillary muscle displacement and 7 sheep with acute inferobasal infarcts studied in vivo

Intervention

Cutting the 2 central basal chordae

Comparator

Pre-intervention state (post-infarction or papillary muscle displacement)

Outcome

Mitral regurgitation volume (mL/beat) quantified by 3D echocardiographysurrogate

Cutting a limited number of basal chordae significantly reduces ischemic mitral regurgitation in animal models by improving leaflet coaptation without causing prolapse.

Cite This Study

Messas et al. (2001) studied this question.

synapsesocial.com/papers/6a090a6462c780efd627fd2b https://doi.org/10.1161/hc4201.097135

Topics

Mitral valve intervention

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Chordal Cutting

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Chordal Cutting

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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