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Multimedia Manual of Cardiothoracic... Oct 2022We detail our technique for totally endoscopic, robotic-assisted mitral valve repair with the reimplantation of a ruptured papillary muscle head supported by double...
We detail our technique for totally endoscopic, robotic-assisted mitral valve repair with the reimplantation of a ruptured papillary muscle head supported by double papillary muscle relocation and mitral annuloplasty for the treatment of nonacute ischemic mitral regurgitation.
Topics: Humans; Papillary Muscles; Robotic Surgical Procedures; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Replantation
PubMed: 36314585
DOI: 10.1510/mmcts.2022.058 -
JACC. Cardiovascular Imaging Sep 2019
Topics: Cardiac Resynchronization Therapy; Heart Ventricles; Humans; Mitral Valve; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 30660517
DOI: 10.1016/j.jcmg.2018.07.008 -
The Journal of Thoracic and... Jul 2018
Topics: Breakfast; Heart Neoplasms; Heart Ventricles; Humans; Lipoma; Papillary Muscles
PubMed: 29499869
DOI: 10.1016/j.jtcvs.2018.01.040 -
Insights Into Imaging Aug 2019Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there... (Review)
Review
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
PubMed: 31428880
DOI: 10.1186/s13244-019-0761-3 -
Asian Cardiovascular & Thoracic Annals Jan 2022The surgical management of patients with hypertrophic obstructive cardiomyopathy can be extremely challenging. Relieving the left ventricular outflow tract obstruction... (Review)
Review
The surgical management of patients with hypertrophic obstructive cardiomyopathy can be extremely challenging. Relieving the left ventricular outflow tract obstruction in these patients is often achieved by performing a septal myectomy. However, in many instances, septal reduction alone is not enough to relieve the obstruction. Interventions on the sub-valvular apparatus, including the anomalous chordae tendineae and the abnormal papillary muscles, are often required. In this review, we summarize the embryology and the pathophysiology of the different elements that may contribute to the left ventricular outflow tract obstruction in the setting of hypertrophic obstructive cardiomyopathy. In addition, we highlight the different surgical procedures that a surgeon may adopt to relieve the left ventricular outflow tract obstruction, beyond the septal myectomy.
Topics: Cardiomyopathy, Hypertrophic; Chordae Tendineae; Humans; Papillary Muscles; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 34605271
DOI: 10.1177/02184923211034689 -
Anatomy & Cell Biology Mar 2019This study investigated and classified the various types of moderator band (MB) in relation to the anterior papillary muscle, with the aim of providing anatomical...
This study investigated and classified the various types of moderator band (MB) in relation to the anterior papillary muscle, with the aim of providing anatomical reference information and fundamental knowledge for use when repairing the congenital defects and understanding the conduction system. The study investigated 38 formalin-fixed human hearts of both sexes obtained from donors aged 38-90 years. The MB was evident in 36 of the 38 specimens (94.7%). The morphology of the MB and its connection with the APM took various forms. The MBs that had a distinct shape were classified into three types according to their shape: cylindrical column, long and thin column, and wide and flat column. Types 2 and 3 were the most common, appearing in 15 (41.7%) and 14 (38.9%) of the 36 specimens, respectively, while type 1 was observed in seven specimens (19.4%). Type 3 was divided into subtypes based on their length. The MB usually originated from a single root (91.7%), with the remainder exhibiting double roots. The pairs of roots in the latter cases had different shapes. The originating point of the MB ranged from the supraventricular crest to the apex of the ventricle. The most-common originating point was in the middle (25 of 36 specimens, 69.4%), followed by the upper third (13.9%), the lower third (11.1%), and the top fifth (5.6%) of the interventricular septum. This study has produced fundamental anatomical and clinical information that will be useful when designing cardiac surgical procedures.
PubMed: 30984450
DOI: 10.5115/acb.2019.52.1.38 -
Journal of Clinical Medicine Feb 2023Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using...
Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain.
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; -value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
PubMed: 36836032
DOI: 10.3390/jcm12041497 -
The Journal of Thoracic and... Nov 2014The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce...
OBJECTIVES
The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty.
METHODS
From 2003, 115 patients with severe ischemic mitral regurgitation who underwent papillary muscle relocation plus nonrestrictive mitral annuloplasty and coronary artery bypass grafting were retrospective analyzed. Patients' mean age was 52±12.8 years, New York Heart Association class III or IV was 71%, and preoperative left ventricular ejection fraction was 43%±6%. The study end points were New York Heart Association functional class, reversal in left ventricle remodeling, reduction of mean tenting area and mean coaptation depth, freedom from cardiac-related deaths and events, and freedom from recurrent mitral regurgitation. Follow-up data were obtained in all patients and were 100% complete. Mean follow-up was 45±6 months.
RESULTS
Five-year freedom from cardiac-related death and events was 91.3%±1.6% and 84%±2.2%, respectively. Recurrent mitral regurgitation more than moderate occurred in 3 patients (2.7%). Reversal in left ventricular remodeling, measured by a change in the end-diastolic and systolic diameter, was observed in our patients (P<.05). The postoperative mean tenting area and mean coaptation depth were 1.1±0.2 cm2 and 0.5±0.2 cm, respectively; 95% of the patients were in New York Heart Association functional class I and II.
CONCLUSIONS
In patients with ischemic mitral regurgitation, papillary muscle relocation plus nonrestrictive mitral annuloplasty promotes a significant reversal in left ventricular remodeling, with a considerable decrease in tenting area and coaptation depth. Our approach is a durable method to reduce the recurrence of mitral insufficiency.
Topics: Adult; Disease-Free Survival; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Myocardial Ischemia; Papillary Muscles; Postoperative Complications; Recurrence; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling
PubMed: 24656671
DOI: 10.1016/j.jtcvs.2014.02.047 -
Journal of Cardiothoracic Surgery Aug 2022Whether it is possible to perform morphological evaluation of functional tricuspid regurgitation (FTR) on contrast-enhanced computed tomography (CT) was examined by...
BACKGROUND
Whether it is possible to perform morphological evaluation of functional tricuspid regurgitation (FTR) on contrast-enhanced computed tomography (CT) was examined by evaluating the relationships between the parameters measured on contrast-enhanced CT and TR severity on transthoracic echocardiography.
METHODS
Fifty patients underwent contrast-enhanced CT. Tricuspid annulus area (TAA), tricuspid annulus circumference (TAC), right ventricular volume (RVV), and the distances between the tips and bases of the papillary muscles were measured on contrast-enhanced CT in diastole and systole. The 50 cases were divided into 34 in the TR ≤ mild group (no TR: 3 cases, trivial TR: 24 cases, mild TR: 7 cases), and 16 in the TR ≥ moderate group (moderate TR: 8 cases, severe TR: 8 cases) using the TR grade measured by transthoracic echocardiography, and then differences between the groups were examined.
RESULTS
Significant differences were found in TAA, TAC, and RVV (p < 0.01) and the distances between the tips of the anterior and posterior papillary muscles (p < 0.05) in both diastole and systole. Since the septal papillary muscle could not be identified in 18 cases (36.0%), only the distance between the anterior and posterior papillary muscles was measurable in all cases. On receiver-operating characteristic (ROC) curve analysis, the areas under the ROC curves (AUCs) of TAA, TAC, and RVV were all > 0.7, and the maximum AUC was 0.925 for dRVV.
CONCLUSIONS
TAA, TAC, RVV, and the distance between the tips of the anterior and posterior papillary muscles measured on contrast-enhanced CT were shown to be significantly increased in the TR ≥ moderate group. Detailed morphological assessment of FTR is possible by contrast-enhanced CT.
Topics: Echocardiography; Humans; Papillary Muscles; Tomography, X-Ray Computed; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 35986292
DOI: 10.1186/s13019-022-01937-0 -
Frontiers in Cardiovascular Medicine 2020The normal mitral valve is a dynamic structure that permits blood to flow from the left atrial (LA) to left ventricle (LV) during diastole and sealing of the LA from the... (Review)
Review
The normal mitral valve is a dynamic structure that permits blood to flow from the left atrial (LA) to left ventricle (LV) during diastole and sealing of the LA from the LV during systole. The main components of the mitral apparatus are the mitral annulus (MA), the mitral leaflets, the chordae tendineae, and the papillary muscles (PM) (Figure 1). Normal valve function is dependent on the integrity and normal interplay of these components. Abnormal function of any one of the components, or their interplay can result in mitral regurgitation (MR). Understanding the anatomy and physiology of all the component of the mitral valve is important for the diagnosis, and for optimal planning of repair procedures. In this review we will focus first on normal anatomy and physiology of the different parts of the mitral valve (MA, leaflets, chordae tendineae, and PM). In the second part we will focus on the pathologic anatomic and physiologic derangements associated with different types of MR.
PubMed: 32548127
DOI: 10.3389/fcvm.2020.00084