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Annals of Thoracic and Cardiovascular... Feb 2022Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of...
OBJECTIVE
Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of specific subvalvular repair in severe IMR have not been elucidated. This is the first nationwide survey regarding surgeons' attitudes toward IMR in Japan.
METHODS
A questionnaire was sent to 543 institutions. From 2015 to 2019, numbers of elective first-time mitral valve replacement (MVR) with/without complete chordal preservation (CCP)/papillary muscle approximation (PMA) and mitral valvuloplasty (MVP) with/without papillary muscle relocation (PMR)/PMA in patients with severe IMR were collected. Concomitant procedures for coronary artery, tricuspid valve, and arrhythmia could be included but left ventricular reconstruction was excluded.
RESULTS
Completed questionnaires were received from 286 institutions (52.7%). The majority (90%) had less than 20 cases within 5 years. The number of MVP (1413, 61.5%) surpassed MVR (886, 38.5%). CCP was performed in half of MVR (50.0%), while PMA was included in only 1.9% of MVR. PMA and PMR were also performed infrequently, in only 7.7% and 10.9% of MVP, respectively.
CONCLUSION
Japanese surgeons aggressively perform MVP for severe IMR. Subvalvular repair was also aggressively performed in addition to MVR, but not to MVP. A multicenter registry study is in progress.
Topics: Follow-Up Studies; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Surveys and Questionnaires; Treatment Outcome
PubMed: 34334538
DOI: 10.5761/atcs.oa.21-00048 -
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 -
Journal of Cardiovascular Echography 2022The rupture of mitral papillary muscles is a very rare complication of infective endocarditis (IE). We report a case of anterolateral papillary muscle rupture resulting...
The rupture of mitral papillary muscles is a very rare complication of infective endocarditis (IE). We report a case of anterolateral papillary muscle rupture resulting in severe mitral regurgitation due to IE in a young man without previous heart disease. The patient underwent urgent mitral valve replacement. The isolated rupture of the mitral papillary muscle complicating IE is rare. Urgent surgery should be performed is such cases.
PubMed: 35669128
DOI: 10.4103/jcecho.jcecho_57_21 -
The Annals of Thoracic Surgery Sep 2020Left atrioventricular valve regurgitation (LAVVR) after atrioventricular canal (AVC) repair remains a significant cause of morbidity. Papillary muscle arrangement may be...
BACKGROUND
Left atrioventricular valve regurgitation (LAVVR) after atrioventricular canal (AVC) repair remains a significant cause of morbidity. Papillary muscle arrangement may be important. To investigate the implications of left mural leaflet morphology, we examined anatomic characteristics of the LAVV to determine possible associations with postoperative LAVVR.
METHODS
All patients with biventricular AVC repair at our institution between January 1, 2011, and December 31, 2016, with necessary imaging were retrospectively reviewed. We assessed papillary muscle structure and novel measures of the left mural leaflet from preoperative echocardiograms and the degree of LAVVR from the first and last available follow-up echocardiograms. Associations with degree of early and late postoperative LAVVR were assessed with t tests, analysis of variance, or χ or Fisher exact tests, and multivariable logistic regression.
RESULTS
There were 58 of 156 patients (37%) with significant (moderate or severe) early postoperative LAVVR, and 30 of 93 (32%) had significant LAVVR after 6 or more months. Fewer patients with closely spaced or asymmetric papillary muscles had moderate or severe late LAVVR vs those with widely spaced papillary muscles (17% vs 40%, P = .019). Controlling for weight at operation, genetic syndromes, and bypass time, widely spaced papillary muscles increased the odds ratio for late LAVVR to 3.6 (P = .026). Larger mural leaflet area was also associated with late LAVVR on univariable (P = .019) and multivariable (P = .023) analyses. One-third of patients with significant late LAVVR had no significant early postoperative regurgitation.
CONCLUSIONS
Mural leaflet and papillary muscle anatomy are associated with late LAVVR after AVC repair. Late regurgitation can develop in the absence of early LAVVR, suggesting different mechanisms.
Topics: Cardiac Surgical Procedures; Echocardiography; Female; Follow-Up Studies; Heart Septal Defects; Humans; Infant; Male; Mitral Valve Insufficiency; Papillary Muscles; Retrospective Studies; Time Factors
PubMed: 32088289
DOI: 10.1016/j.athoracsur.2020.01.012 -
The Journal of Innovations in Cardiac... Feb 2018The discovery, characterization, and ablation of the papillary muscles have evolved rapidly since the initial description in 2008. New innovations in pacemapping,... (Review)
Review
The discovery, characterization, and ablation of the papillary muscles have evolved rapidly since the initial description in 2008. New innovations in pacemapping, intracardiac imaging, ablation catheters, and ablation methodologies have dramatically impacted the approach to the treatment of papillary muscle ventricular arrhythmias. This review provides an up-to-date summary of these methods, as well as guidance on how to integrate them into clinical practice.
PubMed: 32477795
DOI: 10.19102/icrm.2018.090202 -
Indian Heart Journal 2018The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could...
INTRODUCTION
The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could be found. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Detailed knowledge of normal anatomy and variations is vital for accurate interpretation of information by echocardiography and for surgical repair.
MATERIALS AND METHODS
The material for present study consisted of 52 formalin fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the left ventricle and to expose the papillary muscles. According to their attitudinal position they were described as supero-lateral (S-L) and inferoseptal muscle (I-S) instead of conventional anterolateral and posteromedial. Different morphological features of papillary muscles were noted and measurements were taken.
RESULTS
Classical picture of left ventricular papillary muscle was found only in 25% cases. Additionally extra muscles were found 34.61% and 71.15% in S-L and I-S group, respectively. Different shapes and pattern of papillary muscles were also been identified. An additional attribute of this study was measurement of length and breadth of papillary muscles which thus provides a base line data for further detailed studies in a large scale.
CONCLUSION
Oriental nomenclature is necessary not only for anatomist but also for electrocardiographers. Breadth of papillay muscle should be taken into morphometric account as for screening of hypertrophic cardiomyopathy. Proper anatomical knowledge is crucial for clinicians, surgeons and radiologists.
Topics: Adult; Cadaver; Cardiomyopathy, Hypertrophic; Female; Heart Ventricles; Humans; Male; Mitral Valve; Papillary Muscles
PubMed: 30580862
DOI: 10.1016/j.ihj.2017.12.003 -
JACC. Case Reports Sep 2022
PubMed: 36213877
DOI: 10.1016/j.jaccas.2022.08.003 -
IDCases 2022
PubMed: 35498907
DOI: 10.1016/j.idcr.2022.e01504 -
BioMed Research International 2018The antiarrhythmic effect of amiodarone and its analogue dronedarone is caused by their direct actions on several cardiomyocyte sarcolemmal ion currents. However,...
The antiarrhythmic effect of amiodarone and its analogue dronedarone is caused by their direct actions on several cardiomyocyte sarcolemmal ion currents. However, whether their effects are related to intracellular calcium levels is not exactly known. Ca cycling refers to the release and reuptake of intracellular Ca, which induces muscle contraction and relaxation and determines the force-interval dependence. This study aimed to evaluate the influence of amiodarone and dronedarone on the force-interval relationship. . The work was performed on the papillary muscles of the left ventricle of male Wistar rats. Muscle perfusion was performed at 36.5°C with oxygenated Krebs-Henseleit solution with baseline stimulation 0.5 Hz. The postrest test (4-60 s) and the extrasystolic exposure (0.2-1.5 s) were evaluated. Inotropic reaction to the test exposure was evaluated before and after muscle perfusion with solution containing amiodarone (10 M) or dronedarone (10 M) during 10 min. Amiodarone or dronedarone led to decrease of the amplitude of extrasystolic contractions of the papillary muscles. The amplitude of postextrasystolic contractions after short extrasystolic intervals on the background of the drugs was increased. Amiodarone and dronedarone led to increase of the amplitude of postrest contractions. . Dronedarone reduces the excitability of cardiomyocyte sarcolemma to a greater extent than amiodarone. Amiodarone and dronedarone are able to increase postextrasystolic and postrest potentiation. The effect of amiodarone on postextrasystolic and postrest potentiation is more pronounced in comparison with dronedarone.
Topics: Amiodarone; Animals; Anti-Arrhythmia Agents; Cross-Sectional Studies; Dronedarone; Male; Myocardium; Rats; Rats, Wistar
PubMed: 30155479
DOI: 10.1155/2018/4737489 -
Annals of Biomedical Engineering Dec 2021Ischemic mitral regurgitation (IMR) is particularly challenging to repair with lasting durability due to the complex valvular and subvalvular pathologies resulting from...
Ischemic mitral regurgitation (IMR) is particularly challenging to repair with lasting durability due to the complex valvular and subvalvular pathologies resulting from left ventricular dysfunction. Ex vivo simulation is uniquely suited to quantitatively analyze the repair biomechanics, but advancements are needed to model the nuanced IMR disease state. Here we present a novel IMR model featuring a dilation device with precise dilatation control that preserves annular elasticity to enable accurate ex vivo analysis of surgical repair. Coupled with augmented papillary muscle head positioning, the enhanced heart simulator system successfully modeled IMR pre- and post-surgical intervention and enabled the analysis of adjunctive subvalvular papillary muscle repair to alleviate regurgitation recurrence. The model resulted in an increase in regurgitant fraction: 11.6 ± 1.7% to 36.1 ± 4.4% (p < 0.001). Adjunctive papillary muscle head fusion was analyzed relative to a simple restrictive ring annuloplasty repair and, while both repairs successfully eliminated regurgitation initially, the addition of the adjunctive subvalvular repair reduced regurgitation recurrence: 30.4 ± 5.7% vs. 12.5 ± 2.6% (p = 0.002). Ultimately, this system demonstrates the success of adjunctive papillary muscle head fusion in repairing IMR as well as provides a platform to optimize surgical techniques for increased repair durability.
Topics: Animals; Cardiac Surgical Procedures; Dilatation; Disease Models, Animal; Equipment Design; Hemodynamics; Humans; Mitral Valve Insufficiency; Papillary Muscles; Recurrence; Swine
PubMed: 34734363
DOI: 10.1007/s10439-021-02879-9