Reverse ventricular remodeling reduces ischemic mitral regurgitation: Echo-guided device application in the beating heart

In ischemic mitral regurgitation (MR), mitral leaflet closure is restricted by ventricular remodeling with displacement of the papillary muscles (PMs). Therapy is uncertain because ring annuloplasty does not alleviate PM displacement. We tested the hypothesis that echo-guided PM repositioning using...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2002-11, Vol.106 (20), p.2594-2600
Main Authors: HUNG, Judy, GUERRERO, J. Luis, HANDSCHUMACHER, Mark D, SUPPLE, Gregory, SULLIVAN, Suzanne, LEVINE, Robert A
Format: Article
Language:English
Subjects:
Angioplasty, Balloon - methods
Animals
Biological and medical sciences
Cardiology. Vascular system
Echocardiography
Echocardiography, Three-Dimensional
Endocardial and cardiac valvular diseases
Heart
Hemodynamics
Medical sciences
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - etiology
Mitral Valve Insufficiency - physiopathology
Mitral Valve Insufficiency - therapy
Myocardial Contraction
Myocardial Infarction - complications
Myocardial Ischemia - diagnostic imaging
Myocardial Ischemia - physiopathology
Myocardial Ischemia - therapy
Papillary Muscles - diagnostic imaging
Sheep
Ventricular Function, Left
Ventricular Remodeling
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Summary:In ischemic mitral regurgitation (MR), mitral leaflet closure is restricted by ventricular remodeling with displacement of the papillary muscles (PMs). Therapy is uncertain because ring annuloplasty does not alleviate PM displacement. We tested the hypothesis that echo-guided PM repositioning using an external device can reduce MR without compromising left ventricular (LV) function. We studied 10 sheep with ischemic MR produced by circumflex ligation with inferior infarction, 6 acutely and 4 eight weeks after myocardial infarction (MI). A Dacron patch containing an inflatable balloon was placed over the PMs and adjusted under echo guidance to reverse LV remodeling and reposition the infarcted PM. 3D echo assessed mitral valve geometric changes. In 7 sheep, sonomicrometry and Millar catheters assessed changes in end-systolic and end-diastolic pressure-volume relationships, and microspheres were injected to assess coronary flow. Moderate MR after MI resolved with patch application alone (n=3) or echo-guided balloon inflation, which repositioned the infarcted PM, decreasing the PM tethering distance from 31.1+/-2.5 mm after MI to 26.8+/-1.8 with patch (P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000038363.83133.6D