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November 1, 2002European Journal of Cardio-Thoracic SurgeryOpen Access

The effects of mitral annuloplasty rings on mitral valve complex 3-D geometry during acute left ventricular ischemia

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Why the study?

Does mitral ring annuloplasty prevent perturbations of mitral valve 3-D geometry and ischemic mitral regurgitation during acute left ventricular ischemia in a sheep model?

Population

16 sheep undergoing acute left ventricular ischemia via balloon occlusion of the circumflex artery

Comparison

Duran ring annuloplasty or Physio ring… vs Control group (no annuloplasty ring)

Design

Preclinical

Follow-up

1 week

Authors

DLDonna LaiThe University of SydneyTTTomasz A. TimekGrand Rapids Community CollegeFTFrederick A. TibayanOregon Health & Science University

Discussion

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Implication

Annuloplasty rings may avert ischemic MR via annular stabilization in acute ovine ischemia; extends mechanistic insights but leaves open human translation.

Key Points

  • To determine how flexible and semi-rigid annuloplasty rings alter the 3-D geometry of the mitral valve complex during acute left ventricular ischemia.
  • Implanted radiopaque markers on the mitral leaflets, annulus, papillary muscle tips, and left ventricle across three sheep cohorts: control (n = 5), Duran ring (n = 6), and Physio ring (n = 5).
  • Measured 3-D marker coordinates at end-systole one week post-surgery before and during circumflex coronary artery balloon occlusion.
  • In control sheep, acute ischemia caused lateral annular displacement, septal-lateral annular dilatation, apical restriction of the posterior leaflet, and acute ischemic mitral regurgitation.
  • Both Duran and Physio rings prevented septal-lateral leaflet separation, posterior leaflet restriction, and ischemic mitral regurgitation, despite persistent displacement of the posterior papillary muscle.
  • Flexible Duran rings permitted posterior movement of the lateral annulus and posterior leaflet edge, whereas semi-rigid Physio rings immobilized both structures.

Structured PICO

Does mitral ring annuloplasty prevent perturbations of mitral valve 3-D geometry and ischemic mitral regurgitation during acute left ventricular ischemia in a sheep model?

P
Population
16 sheep (n=5 control, n=6 Duran ring, n=5 Physio ring) undergoing acute left ventricular ischemia via balloon occlusion of the circumflex artery
I
Intervention
Duran ring annuloplasty (flexible) or Physio ring annuloplasty (semi-rigid)
C
Comparator
Control group (no annuloplasty ring)
O
Outcome
3-D marker coordinates of mitral leaflet edges, annulus, papillary muscle tips, and ventricle at end-systole, and presence of ischemic mitral regurgitationsurrogate

In a sheep model of acute LV ischemia, both flexible and semi-rigid annuloplasty rings prevented ischemic mitral regurgitation by fixing the septal-lateral annular dimension and preventing lateral displacement of the lateral annulus.

Cite This Study

Lai et al. (2002) studied this question.

synapsesocial.com/papers/6a856500a25be93668ad923dhttps://doi.org/10.1016/s1010-7940(02)00530-4

Topics

Mitral valve intervention
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation.1983 · 272 citations
  2. 2Experimental evaluation of different chordal preservation methods during mitral valve replacement1994 · 91 citations
  3. 3Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.1987 · 165 citations
  4. 4Restricted posterior leaflet motion after mitral ring annuloplasty1999 · 113 citations
  5. 5Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation2001 · 313 citations