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Current Problems in Cardiology Mar 2021Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and the most common cause of sudden cardiac death in young population, especially in... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and the most common cause of sudden cardiac death in young population, especially in athletes under 35 years old. Mutations occur primarily in the β-myosin heavy chain gene and involve the cardiac myosin-binding protein C gene. In this review we would like to focus on the importance of the examination of mitral valve apparatus and the mitral valve abnormalities in patients with HCM. Abnormalities in mitral valve (elongated mitral leaflets, displacement of papillary muscles, and systolic anterior motion) may be the primary pathognomonic elements, even in the absence of hypertrophy. Echocardiography is the gold standard for the diagnosis of HCM. Magnetic resonance imaging emerges as one of the most important imaging modalities for precise diagnosis, assisting in risk stratification and treatment strategy. Mitral valve abnormalities take part fundamentally in the formation of systolic anterior motion of the mitral valve and, they have substantially been repaired surgically. Although myectomy addresses the septum reduction, obstruction relief should be maximally achieved with a potential combination of myectomy and mitral valve repair.
Topics: Cardiomyopathy, Hypertrophic; Echocardiography; Humans; Mitral Valve; Papillary Muscles; Ventricular Outflow Obstruction
PubMed: 32586596
DOI: 10.1016/j.cpcardiol.2020.100641 -
European Journal of Cardio-thoracic... Jan 2022Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient...
OBJECTIVES
Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry.
METHODS
Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality.
RESULTS
A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031).
CONCLUSIONS
Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome.
CLINICAL TRIAL REGISTRATION
clinicaltrials.gov: NCT03848429.
Topics: Aged; Coronary Artery Bypass; Hospital Mortality; Humans; Mitral Valve Insufficiency; Myocardial Infarction; Papillary Muscles
PubMed: 34718501
DOI: 10.1093/ejcts/ezab469 -
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 -
Journal of the College of Physicians... Oct 2020Parachute mitral valve is a rare congenital heart defect characterised by a distorted mitral geometry with a single papillary muscle for all mitral chords to attach. It...
Parachute mitral valve is a rare congenital heart defect characterised by a distorted mitral geometry with a single papillary muscle for all mitral chords to attach. It may develop in isolation or as a constillation of Shone syndrome. By comprehensive retrieval of the pertinent articles published since 2000, 22 articles with 149 cases of parachute mitral valve were recruited into this study. The present article revealed that most patients with a parachute mitral valve had a stenotic or regurgitant mitral valve, which is often associated with left heart obstructions, thereby leading to haemodynamic compromise. Therefore, multiple surgical maneuvers are warranted for such patients. Mitral valve repair is preferred over mitral valve replacement for the mitral valve abnormalities so as to avoid the associated complications of valve replacement procedure. The patients' outcomes are satisfactory with a total event-free survival of surgical patients of 84.8%. Key Words: Cardiac surgical procedures, Congenital heart defects, Mitral valve.
Topics: Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Mitral Valve; Mitral Valve Stenosis; Papillary Muscles
PubMed: 33143830
DOI: 10.29271/jcpsp.2020.10.1069 -
Magnetic Resonance Imaging May 2021In clinical applications of cardiac left ventricle (LV) segmentation, the segmented LV is desired to include the cavity, trabeculae, and papillary muscles, which form a...
In clinical applications of cardiac left ventricle (LV) segmentation, the segmented LV is desired to include the cavity, trabeculae, and papillary muscles, which form a convex shape. However, the intensities of trabeculae and papillary muscles are similar to myocardium. Consequently, segmentation algorithms may easily misclassify trabeculae and papillary muscles as myocardium. In this paper, we propose a level set method with a convexity preserving mechanism to ensure the convexity of the segmented LV. In the proposed level set method, the curvature of the level set contours is used to control their convexity, such that the level set contour is finally deformed as a convex shape. The experimental results and the comparison with other level set methods show the advantage of our method in terms of segmentation accuracy. Compared with the state-of-the-art methods using deep-learning, our method is able to achieve comparable segmentation accuracy without the need for training, while the deep-learning based method requires a large set of training data and high-quality manual segmentation. Therefore, our method can be conveniently used in situation where training data and their manual segmentation are not available.
Topics: Heart Ventricles; Humans; Image Processing, Computer-Assisted; Machine Learning; Magnetic Resonance Imaging
PubMed: 33592247
DOI: 10.1016/j.mri.2021.02.003 -
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 -
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 -
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 -
JAMA Cardiology Sep 2020Malignant arrhythmic mitral valve prolapse (MVP) phenotype poses a substantial risk of sudden cardiac death (SCD), and an estimated 26 000 individuals in the United... (Review)
Review
IMPORTANCE
Malignant arrhythmic mitral valve prolapse (MVP) phenotype poses a substantial risk of sudden cardiac death (SCD), and an estimated 26 000 individuals in the United States are at risk of SCD per year. Thus, identifying risk-stratification strategies for SCD is imperative.
OBSERVATIONS
Patients with MVP have a heterogenous clinical spectrum, ranging from a benign course to a devastating complication such as SCD. Some of the high-risk markers of MVP, which are identified electrocardiographically, include inverted or biphasic T waves, QT dispersion, QT prolongation, and premature ventricular contractions originating from the left ventricular outflow tract and papillary muscles. Morphofunctional characteristics of SCD are leaflet thickness of 5 mm or greater, mitral annulus disjunction, paradoxical systolic increase of the mitral annulus diameter, increased tissue Doppler velocity of the mitral annulus, and higher mechanical dispersion on echocardiography and fibrosis identified by late gadolinium enhancement on cardiac magnetic resonance imaging.
CONCLUSIONS AND RELEVANCE
Findings from this review suggest that SCD can occur earlier in the course of MVP from complex arrhythmias that are triggered by the repeated tugging and traction of the chordopapillary muscle unit and basal mid-myocardium, even before macrofibrosis can be identified in these regions by late gadolinium enhancement on cardiac magnetic resonance imaging. Some of the newer markers identified by speckle-tracking Doppler, such as mechanical dispersion, myocardial work index, and postsystolic shortening, need further validation in a larger population.
Topics: Death, Sudden, Cardiac; Global Health; Humans; Mitral Valve Prolapse; Papillary Muscles; Survival Rate
PubMed: 32936277
DOI: 10.1001/jamacardio.2020.1412 -
Echocardiography (Mount Kisco, N.Y.) Sep 2022Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%-2.4% in general population and it is characterized by a benign course. Although... (Review)
Review
Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%-2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called "malignant MVP" characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c-VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with "arrhythmic MVP" (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T-wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE-CMR and anatomy studies. TTE could be a co-partner in phenotyping high-risk arrhythmic MVP patients.
Topics: Arrhythmias, Cardiac; Bundle-Branch Block; Contrast Media; Death, Sudden, Cardiac; Echocardiography; Gadolinium; Humans; Mitral Valve Prolapse; Papillary Muscles; Phenotype
PubMed: 36029124
DOI: 10.1111/echo.15439