Abstract

OBJECTIVE
The study of the mitral valve apparatus and its modifications during functional mitral regurgitation (FMR) is better revealed by 3-dimensional (3D) transesophageal echocardiography (TOE). To plan mitral valve repair by annuloplasty and papillary muscle (PPM) relocation, we proposed a valve repair procedure oriented by the new main features obtained by real-time 3D TOE reconstruction of the mitral valve apparatus.
METHODS
Since January 2008, 25 patients with severe FMR before mitral valve repair were examined. Mean coaptation depth and mean tenting area were 1.3 ± 0.2 cm and 3.2 ± 0.5 cm(2), respectively. Intraoperative 2D and 3D TOE were performed, followed by a 3D offline reconstruction of the mitral valve apparatus. A schematic mitral valve apparatus model was obtained. A geometric model like a truncated cone was traced in according to the preoperative measurements. The size of the prosthetic ring was selected preoperatively according to the anterior leaflet surface. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth about 0.6 cm was used to detect the new position of the PPM tips.
RESULTS
Offline reconstruction of the mitral valve apparatus and respective truncated cone were feasible in all patients. The expected position of the PPM tips desirable to reach a normal tenting area with a coaptation depth 0.6 cm or less was obtained in all patients. After surgery, all parameters were calculated and no statistically significant difference was found compared with the expected data.
CONCLUSIONS
PPM relocation plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results for patients with severe FMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.

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Publisher Full Text

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Authors

Fattouch K, Murana G, Castrovinci S, Mossuto C, Sampognaro R, Borruso MG, Bertolino EC, Caccamo G, Ruvolo G, Lancellotti P

Institution

Department of Cardiac Surgery, University of Palermo, Palermo, Italy. khalilfattouch@hotmail.com

Source

The Journal of thoracic and cardiovascular surgery 143:4 Suppl 2012 Apr pg S38-42

MeSH

Aged
Blood Vessel Prosthesis Implantation
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Humans
Image Interpretation, Computer-Assisted
Italy
Middle Aged
Mitral Valve
Mitral Valve Annuloplasty
Mitral Valve Insufficiency
Papillary Muscles
Predictive Value of Tests
Severity of Illness Index
Treatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22285328