The power of ultrasound: treating secondary MR with sound waves

Innovations in physics and its applications often enable medical advances. Collaboration between physicists who developed a high-frame-rate ultrasound system and cardiovascular investigators has allowed non-invasive measurement of vascular and myocardial stiffness.1,2 In this current issue of the European Heart Journal—Cardiovascular Imaging , members of these groups, using a related technology, have employed ultrasound to treat as well as to image the heart3 in mitral regurgitation (MR) secondary to myocardial infarction (MI) that causes mitral valve (MV) leaflet tethering mediated by chordae to the displaced papillary muscles (PMs).4 This is a condition for which a strong need is perceived for improved approaches.5 Although there is evidence for adaptive MV growth in secondary MR,6,7 this extra leaflet tissue is often insufficient to compensate adequately for mitral annular (MA) enlargement and chordal tethering.8 The MV leaflets thus become increasingly taut, being pulled by the annulus towards the base, and by chordae towards the left ventricular (LV) apex. The normally convex MV closing configuration towards left atrium becomes concave, and the anterior MV leaflet appears like a ‘hockey stick’ on Echo.9 Once the necessary leaflet tissue redundancy for MV coaptation is …