Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation - Insights from 3-dimensional echocardiography
Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation - Insights from 3-dimensional echocardiography
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DOI：
10.1161/01.cir.101.23.2756
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发表时间：
2000-06-13
期刊：
影响因子：
37.8
通讯作者：
Levine, RA
中科院分区：
文献类型：
--
作者：
Liel-Cohen, N;Guerrero, JL;Levine, RA
背景-来自3D超声心动图(ECHO)的机械学见解可以指导治疗。尤其是，缺血性二尖瓣返流(MR)很难修复，尽管环状缩小，但经常持续存在。我们假设(1)在进展性MR的慢性脑梗塞模型中，返流与二尖瓣小叶附着的3D改变平行，导致小叶拴系和限制闭合；因此，(2)MR可以通过恢复拴系几何结构恢复到正常，使用基于3D回声发现的新的心室重建方法。方法和结果-我们研究了10只绵羊在回旋支边缘结扎后和8周后的3D ECHO。随着左心室(LV)扩张，乳头肌向后内侧移位，从乳头肌尖端到二尖瓣前环的瓣叶拴系距离增加，MR开始消失，但逐渐变得温和(P
Background-Mechanistic insights from 3D echocardiography (echo) can guide therapy. In particular, ischemic mitral regurgitation (MR) is difficult to repair, often persisting despite annular reduction. We hypothesized that (1) in a chronic infarct model of progressive MR, regurgitation parallels 3D changes in the geometry of mitral leaflet attachments, causing increased leaflet tethering and restricting closure; therefore, (2) MR can be reduced by restoring tethering geometry toward normal, using a new ventricular remodeling approach based on 3D echo findings.Methods and Results-We studied 10 sheep by 3D echo just after circumflex marginal ligation and 8 weeks later. MR, at first absent, became moderate as the left ventricle (LV) dilated and the papillary muscles shifted posteriorly and mediolaterally, increasing the leaflet tethering distance from papillary muscle tips to the anterior mitral annulus (P