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Cardiovascular Ultrasound Apr 2010Various structural anomalies of the left ventricular papillary muscles have been observed in recent years. Many of these have been linked to electrocardiographic...
Various structural anomalies of the left ventricular papillary muscles have been observed in recent years. Many of these have been linked to electrocardiographic aberrations. Recently two reports have appeared where the base of the posterior papillary muscle was identified as the source of frequent premature ventricular complexes. In some of these patients these frequent premature ventricular complexes have led to left ventricular dysfunction. In this report a newly discovered structural variant of the anterior papillary muscle is described--the bifid papillary muscle. Furthermore, it is proposed that this bifid papillary muscle is the source of frequent ventricular premature complexes, presenting as bigeminy in a patient with normal left ventricular function.
Topics: Echocardiography; Electrocardiography; Female; Humans; Middle Aged; Papillary Muscles; Ventricular Function, Left; Ventricular Premature Complexes
PubMed: 20409312
DOI: 10.1186/1476-7120-8-13 -
Journal of Cardiothoracic Surgery Mar 2024Ischaemic secondary mitral regurgitation (ISMR) after surgery is due to the displacement of papillary muscles resulting from progressive enlargement of the left... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Ischaemic secondary mitral regurgitation (ISMR) after surgery is due to the displacement of papillary muscles resulting from progressive enlargement of the left ventricle end-diastolic diameter (LVEDD). Our aim was to prove that if the interpapillary muscle distance (IPMD) is surgically stabilized, an increase in LVEDD will not lead to a recurrence of ischaemic mitral regurgitation (MR).
METHODS
Ninety-six patients with ISMR, who underwent surgical revascularisation and annuloplasty, were randomly assigned in a 1:1 ratio to undergo papillary muscle approximation (PMA). At the 5-year follow-up, we assessed the correlation between PMA and echocardiographic improvements, the effect size of PMA on echocardiographic improvements, and a prediction model for recurrent MR using inferential tree analysis.
RESULTS
There was a significant correlation between PMA and enhancements in both the α and β angles (Spearman's rho > 0.7, p < 0.01). The α angle represents the angle between the annular plane and either the A2 annular-coaptation line or the P2 annular-coaptation line. The β angle indicates the angle between the annular plane and either the A2 annular-leaflet tip line or the P2 annular-leaflet tip line. PMA led to substantial improvements in LVEDD, tenting area, α and β angles, with a large effect size (Hedge's g ≥ 8, 95% CI ORs ≠ 1). The most reliable predictor of recurrent MR grade was the interpapillary distance, as only patients with an interpapillary distance greater than 40 mm developed ≥ 3 + grade MR. For patients with an IPMD of 40 mm or less, the best predictor of recurrent MR grade was LVEDD. Among the patients, only those with LVEDD greater than 62 mm showed moderate (2+) MR, while only those with LVEDD less than or equal to 62 mm had absent to mild (1+) MR.
CONCLUSION
Prediction of recurrent ischaemic MR is not independent of progressive LVEDD increase. PMA-based surgical procedure stabilises IPMD.
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve; Echocardiography; Papillary Muscles; Heart Ventricles; Mitral Valve Annuloplasty
PubMed: 38509555
DOI: 10.1186/s13019-024-02631-z -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Apr 2023The incidence of acute myocardial infarction (AMI) is increasing. Acute papillary muscle rupture is one of the serious and rare mechanical complications of AMI, which...
The incidence of acute myocardial infarction (AMI) is increasing. Acute papillary muscle rupture is one of the serious and rare mechanical complications of AMI, which occurs mostly in inferior and posterior myocardial infarction. A patient with acute inferior myocardial infarction developed pulmonary edema and refractory shock, followed by cardiac arrest. After cardiopulmonary resuscitation (CPR), revascularization of criminal vessels was carried out by emergency percutaneous transluminal coronary angioplasty (PTCA) under the support of intra-aortic balloon pump (IABP) and extra corporeal membrane oxygenation (ECMO). Although the patient was given a chance for surgery, his family gave up treatment due to unsuccessful brain resuscitation. It reminds that mechanical complications such as acute papillary muscle rupture, valvular dysfunction and rupture of the heart should be highly suspected when cardiogenic pulmonary edema and cardiogenic shock are difficult to correct in acute inferior myocardial infarction. Echocardiogram and surgery should be put forward when revascularization of criminal vessels is available.
Topics: Humans; Inferior Wall Myocardial Infarction; Papillary Muscles; Pulmonary Edema; Myocardial Infarction; Shock, Cardiogenic
PubMed: 37385627
DOI: 10.11817/j.issn.1672-7347.2023.220365 -
Texas Heart Institute Journal Sep 2021
Topics: Heart Rupture; Heart Rupture, Post-Infarction; Humans; Inferior Wall Myocardial Infarction; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 34637518
DOI: 10.14503/THIJ-18-6717 -
The Journal of Thoracic and... Apr 2012The study of the mitral valve apparatus and its modifications during functional mitral regurgitation (FMR) is better revealed by 3-dimensional (3D) transesophageal...
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.
Topics: 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
PubMed: 22285328
DOI: 10.1016/j.jtcvs.2012.01.010 -
Sheng Li Xue Bao : [Acta Physiologica... Feb 2011It is proved that polydatin has cardioprotection against ischemia-induced arrhythmia, but the electrophysiological mechanism is not clear. The aim of the present study...
It is proved that polydatin has cardioprotection against ischemia-induced arrhythmia, but the electrophysiological mechanism is not clear. The aim of the present study was to investigate the effect of polydatin on action potential (AP) in ventricular papillary muscle and the underlying ionic mechanism in rat using intracellular recording and whole-cell patch clamp techniques. The results showed: (1) In normal papillary muscles, polydatin (50 and 100 µmol/L) shortened duration of 50% repolarization (APD(50)) and duration of 90% repolarization (APD(90)) in a concentration-dependent manner (P<0.01). But polydatin had no effects on resting potential (RP), overshoot (OS), amplitude of action potential (APA) and maximal rate of depolarization in phase 0 (V(max)) in normal papillary muscles (P>0.05). (2) In partially depolarized papillary muscles, polydatin (50 µmol/L) not only shortened APD(50) and APD(90) (P<0.05), but also decreased OS, APA and V(max) (P<0.05). (3) After pretreatment with glibenclamide (10 µmol/L), an ATP-sensitive K(+) channel blocker, the electrophysiological effect of polydatin (50 µmol/L) was partially inhibited. (4) Pretreatment with N(G)-nitro-L-arginine methyl ester (L-NAME, 1 mmol/L), a nitric oxide (NO) synthase inhibitor, failed to abolish the effect of polydatin (50 µmol/L) on AP. (5) Polydatin (25, 50, 75 and 100 µmol/L) decreased L-type Ca(2+) current in ventricular myocytes in a concentration-dependent manner (P<0.05). (6) Polydatin (50 µmol/L) increased ATP-sensitive K(+) current in ventricular myocytes (P<0.05). The results suggest that polydatin can shorten the repolarization of AP in normal papillary muscle and inhibit AP in partially depolarized papillary muscle, which might be related to the blocking of L-type Ca(2+) channel and the opening of ATP-sensitive K(+) channel.
Topics: Action Potentials; Animals; Calcium Channels, L-Type; Drugs, Chinese Herbal; Glucosides; Heart Ventricles; KATP Channels; Male; Papillary Muscles; Rats; Rats, Sprague-Dawley; Stilbenes
PubMed: 21340434
DOI: No ID Found -
BMC Surgery May 2022Percutaneous balloon mitral valvotomy is a common therapeutic approach for rheumatic mitral stenosis. Avulsion of the papillary muscle is a rare but serious complication...
BACKGROUND
Percutaneous balloon mitral valvotomy is a common therapeutic approach for rheumatic mitral stenosis. Avulsion of the papillary muscle is a rare but serious complication of balloon mitral valvotomy. The papillary muscles are derived from the trabecular layer of the developing ventricular walls. When subjected to a force, avulsion of papillary muscle from the trabecular layer may occur.
CASE PRESENTATION
In this case report, we describe a patient with rheumatic mitral stenosis, who experienced avulsion of the mitral papillary muscle from the left ventricular wall after undergoing balloon mitral valvotomy. Papillary muscle alvusion resulted in severe mitral regurgitation, which was finally treated by mitral valve replacement.
CONCLUSION
We successfully diagnosed avulsion of the papillary muscle following balloon mitral valvotomy. Three-dimensional transthoracic echocardiography provides more information on mitral apparatus structure than two-dimensional transthoracic echocardiography.
Topics: Catheterization; Echocardiography; Echocardiography, Three-Dimensional; Humans; Mitral Valve Stenosis; Papillary Muscles
PubMed: 35597976
DOI: 10.1186/s12893-022-01636-6 -
Journal of Cardiovascular... Apr 2022Ablation of papillary muscles (PMs) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect...
INTRODUCTION
Ablation of papillary muscles (PMs) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting.
METHODS
Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50 W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 g. Ablation lesions were sectioned and underwent quantitative morphometric analysis.
RESULTS
A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared with ablation with the catheter parallel to PM tissue (75.26 ± 8.40 mm vs. 34.04 ± 2.91 mm , p < .001) and (3.33 ± 0.18 mm vs. 2.24 ± 0.10 mm, p < .001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33 ± 0.28°C vs. 40.28 ± 0.24°C, p = .003), yet, there were no steam pops in either group.
CONCLUSION
For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths.
Topics: Animals; Catheter Ablation; Catheters; Cattle; Heart Ventricles; Papillary Muscles; Therapeutic Irrigation
PubMed: 35133050
DOI: 10.1111/jce.15408 -
Circulation Journal : Official Journal... 2014Left ventricular outflow tract obstruction (LVOTO) has important prognostic implications in patients with hypertrophic cardiomyopathy (HCM). Echocardiography provides... (Review)
Review
Left ventricular outflow tract obstruction (LVOTO) has important prognostic implications in patients with hypertrophic cardiomyopathy (HCM). Echocardiography provides critical information to establish LVOTO as a unique feature of HCM by demonstrating heterogeneity of hypertrophy patterns and the systolic anterior motion of mitral leaflets, resulting in mitral-septal contact. Currently, 2 treatment strategies are available for reduction of muscle mass to relieve LVOTO: surgical myectomy and percutaneous alcohol septal ablation. Both focus on mechanical removal of the hypertrophied septum. However, this alone is not the best approach to abolishing LVOTO, because recurrence is common and requires additional septal reduction. Recent 3-dimensional in vivo measurements and other noninvasive cardiac imaging modalities have confirmed primary alterations of the mitral valvular apparatus, including leaflet elongation with increased surface area and abnormal displacement of papillary muscles. More importantly, these extra-myocardial changes appear to be independent factors associated with the development of LVOTO. Other important anatomical changes include anomalous papillary muscle insertion into the anterior mitral leaflet and midventricular obstruction because of apposition of the hypertrophied mid-septum and the papillary muscle. Thus, the myocardium is not the only tissue affected in patients with HCM. A tailored approach to correcting primary changes of the mitral valvular apparatus and hypertrophy pattern based on a comprehensive evaluation using noninvasive imaging modalities is necessary to improve long-term outcomes.
Topics: Cardiomegaly; Echocardiography; Humans; Mitral Valve; Papillary Muscles; Ventricular Outflow Obstruction
PubMed: 25008367
DOI: 10.1253/circj.cj-14-0524 -
Japanese Journal of Pharmacology Nov 1994To develop a model to predict the efficacy and adversity of class I antiarrhythmic drugs, intraventricular conduction time (IVCT), coronary blood flow (CBF), developed...
To develop a model to predict the efficacy and adversity of class I antiarrhythmic drugs, intraventricular conduction time (IVCT), coronary blood flow (CBF), developed tension of papillary muscle (DT) and idioventricular automaticity rate (VR) were measured following drug administration in an isolated canine papillary muscle preparation cross-circulated with the heparinized blood of a donor dog. Tetrodotoxin, the prototypic fast Na+ channel blocker, and class I drugs increased IVCT and CBF, but decreased DT and VR, in a dose-dependent manner. The profiles of known class I drugs, procainamide, disopyramide, lidocaine, mexiletine and flecainide were similar, but the potencies of each drug were different. Two new class I drugs, ME3202 and AN-132, were also tested and found to have effects that were similar to that of tetrodotoxin. There was a good correlation between the doses of drugs prolonging IVCT by 50% and the canine antiarrhythmic plasma concentrations in our previous study. This model can also be used to estimate the use-dependency and the kinetics of use-dependent sodium channel block; however, it is not suitable for extensive investigation of cellular and molecular mechanisms. Thus, the use of this model facilitates the comparison of multiple cardiac effects of class I drugs and may be an effective way to better assess new antiarrhythmic drugs.
Topics: Animals; Anti-Arrhythmia Agents; Coronary Circulation; Cross Circulation; Dogs; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Female; Heart Conduction System; Male; Myocardial Contraction; Papillary Muscles; Tetrodotoxin; Verapamil
PubMed: 7869617
DOI: 10.1254/jjp.66.303