A newly designed adapter for testing an ex vivo mitral valve apparatus.
ABSTRACT Few instruments are currently available to test mitral valve function in an ex vivo state due to the technical difficulties involved. To investigate the native ex vivo mitral valve or prosthetic mitral valve with chordae, we developed a mitral valve adapter with an annulus suturing portion and 2 papillary muscle suturing sites that can be changed in angle, direction, and length of chordae. We used this adapter to test an ex vivo mitral apparatus in beagle dogs and evaluated the morphology and function of the mitral apparatus by endoscopy. Our newly designed mitral valve adapter proved extremely useful for examining the ex vivo mitral valve anatomy and function and for testing stentless mitral prostheses with annular-papillary muscle continuity.
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ABSTRACT: Mitral homograft replacement requires a good knowledge of the anatomy of the papillary muscles. Clinical experience with mitral homografts has revealed an as yet unexplored aspect of the morphology of the mitral subvalvular apparatus, that is correspondence between papillary muscle sub-divisions and chordal attachment to the leaflets. To further our understanding we subjected 65 normal hearts to close scrutiny which confirmed our perioperative observations. We could establish a classification based on the ways that the papillary muscles relate to the leaflets via the chordae. Four types are described. In type I the papillary muscle is single. In type II the papillary muscle has two heads, one of which sends chordae exclusively to the posterior leaflet. In type III the papillary muscle is also divided, one head supporting the commissural area exclusively. Type IV PM resembles type III but is distinguished from it in the way that the head supporting the commissure is very short. In this type the different heads also originate at different levels on the ventricular wall from the apex to the base.The Journal of heart valve disease 10/1996; 5(5):472-6. · 1.07 Impact Factor
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ABSTRACT: A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing. From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49.1 years) were operated on. The main causes of mitral valve insufficiency were degenerative, 90; bacterial endocarditis, 15; and rheumatic, 13. The indication for operation was based on the severity of the mitral valve insufficiency (90 patients were in grade III or IV) rather than on functional class (60 patients were in class III or IV). At echocardiography 6 patients had normal leaflet motion (type I), 119 leaflet prolapse (type II), and 12 restricted leaflet motion (type III). Surgical repair was carried out using Carpentier techniques of valve reconstruction. In 3 patients, inadequate ring sizing was responsible for systolic anterior motion of the anterior leaflet diagnosed by intraoperative echo. The valve was replaced in 2 patients. There were three hospital deaths, no late deaths, one reoperation for recurrent mitral valve insufficiency due to chordal rupture 1 month after repair, one reoperation for atrial thrombus formation 5 months after repair, one anticoagulant-related hemorrhage, and one thromboembolic episode. Mid-term follow-up between 6 and 18 months was available in 94 patients. Echocardiography showed trivial or no regurgitation in 93.2% of the patients and minimal regurgitation in 6.8%. The average transmitral diastolic gradient was 3.55 +/- 1.93 mm Hg. Left ventricular end-systolic diameter and volume decreased postoperatively, demonstrating an improved left ventricular function. This preliminary experience has provided promising results and allowed us to define the indications of the Physio-Ring versus the classic ring. It has also shown that valve sizing and proper ring selection are of primary importance.The Annals of Thoracic Surgery 12/1995; 60(5):1177-85; discussion 1185-6. · 3.45 Impact Factor
- Circulation 04/1970; 41(3):459-67. · 15.20 Impact Factor