Mitral valve annuloplasty: a quantitative clinical and mechanical comparison of different annuloplasty devices.
Mitral valve annuloplasty: a quantitative clinical and mechanical comparison of different annuloplasty devices.
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DOI：
10.1007/s10439-011-0442-y
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发表时间：
2012-03
影响因子：
3.8
通讯作者：
Kuhl, Ellen
中科院分区：
文献类型：
--
作者：
Rausch, Manuel K.;Bothe, Wolfgang;Kvitting, John-Peder Escobar;Swanson, Julia C.;Miller, D. Craig;Kuhl, Ellen
二尖瓣瓣环成形术是一种常见的外科技术，用于通过植入瓣环成形术装置来修复泄漏的瓣膜。为了提高修复耐久性，这些装置旨在增加小叶接合，同时保留天然的环形形状和运动；然而，装置植入对环形变形、应变和曲率的精确影响尚不清楚。在这里，我们量化了三种常用设备如何显着损害原生环形动力学。在受控体内实验中，我们通过手术在 34 只羊的二尖瓣环周围植入了 11 个柔性不完整装置、11 个半刚性完整装置和 12 个刚性完整装置，每个装置都标记有 16 个等距钽标记。我们使用双平面视频透视记录了四维标记坐标，首先使用设备，然后不使用设备，这些坐标用于使用分段三次样条创建数学模型。临床指标（特征解剖距离）显示装置植入后环形动力学整体显着降低。机械指标（应变和曲率场）通过前扩张和后收缩的局部损失来解释这种减少。总体而言，所有三种装置都不利地降低了环形动力。然而，柔性不完整装置比完整装置在更大程度上保留了天然环形动力学。异质应变和曲率分布表明需要异质支撑，这可能会利用功能梯度材料的设计概念产生更合理的瓣环成形术装置设计。
Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. Here we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted eleven flexible-incomplete, eleven semi-rigid-complete, and twelve rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally-spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably reduced annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials.
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影响因子：
3.8
作者：
Eckert, Chad E.;Zubiate, Brett;Sacks, Michael S.
通讯作者：
Sacks, Michael S.
影响因子：
5.7
作者：
de Oliveira, JMF;Antunes, MJ
通讯作者：
Antunes, MJ
正常羊心脏心动周期中二尖瓣前叶的曲率。
影响因子：
37.8
作者：
Kvitting JP;Bothe W;Göktepe S;Rausch MK;Swanson JC;Kuhl E;Ingels NB Jr;Miller DC
通讯作者：
Miller DC
影响因子：
3.4
作者：
De Bonis, Michele;Taramasso, Maurizio;Alfieri, Ottavio
通讯作者：
Alfieri, Ottavio
影响因子：
2.4
作者：
Krishnamurthy, Gaurav;Itoh, Akinobu;Bothe, Wolfgang;Swanson, Julia C.;Kuhl, Ellen;Karlsson, Matts;Miller, D. Craig;Ingels, Neil B., Jr.
通讯作者：
Ingels, Neil B., Jr.