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BMC Cardiovascular Disorders Mar 2014Solitary papillary muscle (PM) hypertrophy is an unique type of hypertrophic cardiomyopathy (HCM), which is characterized by predominant papillary muscle hypertrophy...
Solitary accessory and papillary muscle hypertrophy manifested as dynamic mid-wall obstruction and symptomatic heart failure: diagnostic feasibility by multi-modality imaging.
BACKGROUND
Solitary papillary muscle (PM) hypertrophy is an unique type of hypertrophic cardiomyopathy (HCM), which is characterized by predominant papillary muscle hypertrophy sparing the rest of other left ventricular segments. It has recently drawn our attention about the mechanism of left ventricular mid-cavity obstruction and the influence of pressure gradient in the left ventricular outflow tract (LVOT), thus carries clinical importance.
CASE PRESENTATION
We reported a symptomatic, 83-year-old woman who presented with dynamic, high resting left ventricle (LV) mid-wall gradient without obvious septal hypertrophy or systolic anterior motion (SAM). Subsequent real-time (RT) three-dimensional echocardiography (3DE) and cardiac magnetic resonance imaging (MRI) demonstrated large, hypertrophic accessory papillary muscles squeezing mid-cavity of left ventricle producing dynamic pressure gradient during systole in the absence of left ventricular wall anomalies.
CONCLUSION
We proposed that combined use of echocardiography particularly RT-3DE and cardiac magnetic resonance imaging (MRI) can accurately identify this specific type of hypertrophic cardiomyopathy without remarkable traditional features.
Topics: Aged, 80 and over; Cardiomyopathy, Hypertrophic; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Electrocardiography; Female; Heart Failure; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Papillary Muscles; Predictive Value of Tests; Ventricular Function, Left; Ventricular Pressure
PubMed: 24606866
DOI: 10.1186/1471-2261-14-34 -
The Annals of Thoracic Surgery Jul 2019Neochordoplasty is an important repair technique, but optimal anchoring position is unknown. Although typically anchored at papillary muscles, new percutaneous devices... (Comparative Study)
Comparative Study
BACKGROUND
Neochordoplasty is an important repair technique, but optimal anchoring position is unknown. Although typically anchored at papillary muscles, new percutaneous devices anchor the neochordae at or near the ventricular apex, which may have an effect on chordal forces and the long-term durability of the repair.
METHODS
Porcine mitral valves (n = 6) were mounted in a left heart simulator that generates physiologic pressure and flow through the valves, and chordal forces were measured with Fiber Bragg Grating strain gauge sensors. Isolated mitral regurgitation was induced by cutting P2 primary chordae, and the regurgitant valve was repaired with polytetrafluoroethylene neochord with apical anchoring, followed by papillary muscle fixation for comparison. In both situations, the neochord was anchored to a customized force-sensing post positioned to mimic the relevant in vivo placement.
RESULTS
Echocardiographic and hemodynamic data confirmed that the repairs restored physiologic hemodynamics. Forces on the chordae and neochord were lower for papillary fixation than for the apical fixation (p = 0.003). In addition, the maximum rate of change of force on the chordae and neochordae was higher for apical fixation than for papillary fixation (p = 0.028).
CONCLUSIONS
Apical neochord anchoring results in effective repair of mitral regurgitation, albeit with somewhat higher forces on the chordae and neochord suture, as well as an increased rate of loading on the neochord compared with the papillary muscle fixation. These results may guide strategies to reduce stresses on neochordae as well as aid optimal patient selection.
Topics: Animals; Biomechanical Phenomena; Chordae Tendineae; Echocardiography; Hemodynamics; Mitral Valve Insufficiency; Papillary Muscles; Swine
PubMed: 30836099
DOI: 10.1016/j.athoracsur.2019.01.053 -
Journal of the American College of... Mar 1992Previous angiographic observations in patients with mitral valve prolapse have suggested that superior leaflet displacement results in abnormal superior tension on the...
Previous angiographic observations in patients with mitral valve prolapse have suggested that superior leaflet displacement results in abnormal superior tension on the papillary muscle tips that causes their superior traction or displacement. It has further been postulated that such tension can potentially affect the mechanical and electrophysiologic function of the left ventricle. The purpose of this study was to confirm and quantitate this phenomenon noninvasively by using two-dimensional echocardiography to determine whether superior displacement of the papillary muscle tips occurs and its relation to the degree of mitral leaflet displacement. Directed echocardiographic examination of the papillary muscles and mitral anulus was carried out in a series of patients with classic mitral valve prolapse and results were compared with those in a group of normal control subjects. Distance from the anulus to the papillary muscle tip was measured both in early and at peak ventricular systole. In normal subjects, this distance did not change significantly through systole, whereas in the patient group it decreased, corresponding to a superior displacement of the papillary muscle tips toward the anulus in systole (8.5 +/- 2.6 vs. 0.8 +/- 0.7 mm; p less than 0.0001). This superior papillary muscle motion paralleled the superior displacement of the leaflets in individual patients (y = 1.0x + 0.8; r = 0.93) and followed a similar time course.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Echocardiography; Female; Humans; Male; Middle Aged; Mitral Valve Prolapse; Motion; Myocardial Contraction; Papillary Muscles
PubMed: 1538011
DOI: 10.1016/s0735-1097(10)80274-8 -
Hellenic Journal of Cardiology : HJC =... 2020
Topics: Chordae Tendineae; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Infarction; Papillary Muscles; Rupture, Spontaneous; Severity of Illness Index
PubMed: 30366061
DOI: 10.1016/j.hjc.2018.10.004 -
The Tohoku Journal of Experimental... Aug 2007It is important to accurately and conveniently assess the effects of L- and N-type Ca(2+) channel blocking drugs, which are commonly used for treatment of hypertension,...
It is important to accurately and conveniently assess the effects of L- and N-type Ca(2+) channel blocking drugs, which are commonly used for treatment of hypertension, but no method is available to simultaneously assess the effects of them in the same preparation. We have therefore designed an ex vivo method to measure the changes in contractile response of anterior papillary muscle of right ventricle and myocardial interstitial norepinephrine (NE) level using canine blood-perfused papillary muscle preparations. Papillary muscle-developed tension (PMDT) induced by an electronic stimulator was measured with force transducer. Myocardial interstitial NE effluent was collected by microdialysis fiber, which was implanted at the base of the papillary muscle, and measured with high performance liquid chromatography. Cilnidipine, a typical L- and N-type Ca(2+) channel blocker, was used to prove the efficiency of this method. First, to assess the effects of drugs on L-type Ca(2+) channel, the changes in basal PMDT were measured. Cilnidipine and nicardipine, a selective L-type Ca(2+) channel blocker, but not omega-conotoxin GVIA (omega-CTX), a selective N-type Ca(2+) channel blocking peptide, decreased basal PMDT dose-dependently. Second, to assess the effects of drugs on N-type Ca(2+) channel, the changes in PMDT and myocardial interstitial NE level by intracardiac sympathetic ganglion stimulation were measured. Cilnidipine and omega-CTX, but not nicardipine, dose-dependently reduced sympathomimetic increases in PMDT and myocardial interstitial NE level. These results indicate that our method is efficient to assess the effects of various L- and N-type Ca(2+) channel blocking drugs in the same papillary muscle preparation.
Topics: Adrenergic alpha-Agonists; Animals; Calcium Channel Blockers; Calcium Channels, L-Type; Calcium Channels, N-Type; Dihydropyridines; Dogs; Dose-Response Relationship, Drug; Microdialysis; Muscle Contraction; Myocardium; Nicardipine; Norepinephrine; Papillary Muscles; omega-Conotoxin GVIA
PubMed: 17660707
DOI: 10.1620/tjem.212.415 -
British Heart Journal Sep 1977The anatomy of the papillary muscle of the conus, also known as Lancisi's muscle, was studied in 100 normal hearts from pathological collections and in 8 embryonic and...
The anatomy of the papillary muscle of the conus, also known as Lancisi's muscle, was studied in 100 normal hearts from pathological collections and in 8 embryonic and fetal hearts. Wide morphological variations were observed and because of this the name medial papillary complex is proposed. It is concluded that the value of this complex as an anatomical landmark in the right ventricle is a very restricted one. The development of the medial papillary complex is described.
Topics: Adolescent; Adult; Child; Child, Preschool; Fetal Heart; Heart; Humans; Infant; Middle Aged; Papillary Muscles
PubMed: 907765
DOI: 10.1136/hrt.39.9.1012 -
Annals of Surgery Jun 1986Papillary muscle scarring is encountered frequently during operations for sustained ventricular tachycardia (VT). Indications for excision of the papillary muscle scar...
Papillary muscle scarring is encountered frequently during operations for sustained ventricular tachycardia (VT). Indications for excision of the papillary muscle scar and mitral valve replacement (MVR) are controversial. The findings in 46 consecutive patients undergoing operative electrophysiologic map-directed endocardial resections for VT were reviewed. There was papillary muscle scarring in 15 patients (average age: 59 years; sex: 11 male, 4 female; average ejection fraction: 31 +/- 14%). Eleven patients had a VT with the site of origin on a scarred papillary muscle; four had another VT site of origin. Six patients underwent papillary muscle scar resection (5 with MVR); six underwent papillary muscle cryotherapy (-60 C X 2 min); and three had neither papillary muscle resection nor MVR. All six patients with papillary muscle resection +/- MVR are alive and free of arrhythmia after 14.3 +/- 7.6 months of follow-up. Five of six patients treated by papillary muscle cryotherapy alone manifested spontaneous (4 patients) or inducible (1 patient) VT during early postoperative evaluation. Two of the three patients with untreated papillary muscle scarring developed late complications requiring reoperation. One patient developed mitral regurgitation requiring MVR 5 months later. The other developed a previously undocumented VT 2 years after operation. Significant papillary muscle scarring visualized at the time of operation for arrhythmia is an indication for resection of the scar and the papillary muscle, even if this necessitates MVR. In this series, attempts to preserve the papillary muscle, by incomplete resection of the scar or by cryotherapy, resulted in a high failure rate owing to recurrent VT or mitral regurgitation.
Topics: Aged; Cicatrix; Cryosurgery; Electrophysiology; Endocardium; Female; Heart Ventricles; Humans; Intraoperative Period; Male; Middle Aged; Papillary Muscles; Reoperation; Tachycardia
PubMed: 3718031
DOI: 10.1097/00000658-198606000-00014 -
European Journal of Cardio-thoracic... Dec 2013Papillary muscle rupture (PMR) is a rare, but serious mechanical complication of myocardial infarction (MI). Although mitral valve replacement is usually the preferred...
OBJECTIVES
Papillary muscle rupture (PMR) is a rare, but serious mechanical complication of myocardial infarction (MI). Although mitral valve replacement is usually the preferred treatment for this condition, mitral valve repair may offer an improved outcome. In this study, we sought to determine the outcome of mitral valve repair for post-MI PMR and to provide a systematic review of the literature on this topic.
METHODS
Between January 1990 and December 2010, 9 consecutive patients (mean age 63.5 ± 14.2 years) underwent mitral valve repair for partial post-MI PMR. Clinical data, echocardiographic data, catheterization data and surgical reports were reviewed. Follow-up was obtained in December of 2012 and it was complete; the mean follow-up was 8.7 ± 6.1 (range 0.2-18.8 years).
RESULTS
Intraoperative and in-hospital mortality were 0%. Intraoperative repair failure rate was 11.1% (n = 1). Freedom from Grade 3+ or 4+ mitral regurgitation and from reoperation at 1, 5, 10 and 15 years was 87.5 ± 11.7%. Estimated 1-, 5-, 10- and 15-year survival rates were 100, 83.3 ± 15.2, 66.7 ± 19.2 and 44.4 ± 22.2%, respectively. There were 3 late deaths, and 2 were cardiac-related. All late survivors were in New York Heart Association Class I or II. No predictors of long-term survival could be identified.
CONCLUSIONS
Mitral valve repair for partial or incomplete post-MI PMR is reliable and provides good short- and long-term results, provided established repair techniques are used and adjacent tissue is not friable. PMR type and adjacent tissue quality ultimately determine the feasibility and durability of repair.
Topics: Aged; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Infarction; Papillary Muscles; Reoperation; Rupture; Survivors; Treatment Outcome
PubMed: 23520228
DOI: 10.1093/ejcts/ezt150 -
Journal of Cardiothoracic Surgery Jul 2022Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to...
BACKGROUND
Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines.
CASE PRESENTATION
This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge.
CONCLUSION
In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.
Topics: Acute Disease; Endocarditis; Endocarditis, Bacterial; Heart Failure; Heart Rupture; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 35804449
DOI: 10.1186/s13019-022-01854-2 -
The Annals of Thoracic Surgery Oct 1997In the absence of papillary muscle rupture, the precise deformations that cause acute postinfarction mitral valve regurgitation are not understood and impair reparative...
BACKGROUND
In the absence of papillary muscle rupture, the precise deformations that cause acute postinfarction mitral valve regurgitation are not understood and impair reparative efforts.
METHODS
In 6 Dorsett hybrid sheep, sonomicrometry transducers were placed around the mitral annulus (n = 6) and at the tips and bases of both papillary muscles (n = 4). Later, specific circumflex coronary arteries were occluded to infarct approximately 32% of the posterior left ventricle and produce acute 2 to 3+ mitral regurgitation. Before and after infarction, distance measurements between sonomicrometry transducers produced three-dimensional coordinates of each transducer every 5 ms.
RESULTS
After infarction, the annulus dilated asymmetrically orthogonal to the line of leaflet coaptation, but the annular area increased only 9.2% +/- 6.3% (p = 0.02). At end-systole, posterior papillary muscle length increased 2.3 +/- 0.9 mm (p = 0.005); the posterior papillary muscle tip moved closer to the annular plane and centroid, and the anterior papillary muscle tip moved away.
CONCLUSIONS
Small deformations in mitral valvular spatial geometry after large posterior infarctions are sufficient to produce moderate to severe mitral regurgitation. The most important changes are asymmetric annular dilatation, prolapse of leaflet tissue tethered by the posterior papillary muscle, and restriction of leaflet tissue attached to the anterior papillary muscle.
Topics: Animals; Disease Models, Animal; Echocardiography, Doppler, Color; Mitral Valve; Mitral Valve Insufficiency; Myocardial Infarction; Papillary Muscles; Sheep
PubMed: 9354521
DOI: 10.1016/s0003-4975(97)00850-3