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Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation.

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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  • 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