Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve.
Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve.
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DOI：
10.1016/j.jtcvs.2011.10.032
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发表时间：
2012-09
影响因子：
6
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Padala, Muralidhar;Gyoneva, Lazarina;Yoganathan, Ajit P.
二尖瓣前叶上次级腱索的横断以缓解瓣叶束缚并减少返流是一种经实验证明的纠正功能性二尖瓣返流的手术。在本研究中，我们试图研究横断次级腱索是否对同一瓣叶上的边缘腱索力产生影响。在脉动心脏模拟器中研究了成年猪二尖瓣（N =8），其中乳头肌位置可以精确定位。在前缘腱索上安装微型传感器测量腱索力。在基线条件、三种不同的栓系条件[顶侧、顶侧、顶侧后]以及在三种栓系条件下进行腱索切割后，对每个瓣膜进行研究。在每种情况下的时间变化，峰值和平均边缘弦力的报告。根尖栓系平均增加96%的边缘弦力，但在弦切割后保持不变。在顶侧栓系的情况下，边缘弦力从基线增加210%，并且在弦切割后进一步增加到基线的350%。在顶-侧-后栓系后，边缘弦力增加到横断前基线的335%，横断后增加到548%。二次腱索切割后边缘腱索力的增加取决于乳头肌的位置和瓣叶栓系的程度。虽然在最小瓣叶栓系下，腱索切割可能不会改变瓣膜力学，但当瓣叶栓系更明显时，它会显著影响力学，这通常见于功能性二尖瓣返流患者。
Transection of the secondary chordae on the anterior leaflet of the mitral valve to relieve leaflet tethering and reduce regurgitation is an experimentally proven procedure to correct functional mitral regurgitation. In this study, we sought to investigate if transecting the secondary chordae has an impact on the marginal chordal force on the same leaflet. Adult porcine mitral valves (N =8) were studied in a pulsatile heart simulator, in which the papillary muscle positions can be precisely positioned. The anterior marginal chordae were instrumented with miniature transducers to measure the chordal forces. Each valve was studied under baseline conditions, three different tethering conditions [apical, apical-lateral, apical-lateral-posterior], and following chordal cutting in the three tethering conditions. The temporal changes, the peak and average marginal chordal forces under each condition are reported. Apical tethering increased marginal chordal force by an average 96% but remained unchanged after chordal cutting. With apical-lateral tethering, marginal chordal force increased by 210% from baseline, and further increased to 350% of baseline after chordal cutting. After apical-lateral-posterior tethering, the marginal chordal force increased to 335% of baseline before transection and by 548% after the transection. Increase in marginal chordal force after secondary chordal cutting depends on the location of the papillary muscles and the extent of leaflet tethering. While, chordal cutting may not alter the valve mechanics under minimal leaflet tethering, it significantly impacts the mechanics when the leaflet tethering is more pronounced, which is typically seen in patients with functional mitral regurgitation.
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影响因子：
2.4
作者：
Pedersen, L. G.;Zhao, J.;Olsen, L. H.
通讯作者：
Olsen, L. H.
DOI：
10.1067/j.echo.2003.09.003
发表时间：
2003-12-01
影响因子：
6.5
作者：
Nesta, F;Otsuji, Y;Hung, J
通讯作者：
Hung, J
DOI：
10.1016/s0735-1097(98)00627-5
发表时间：
1999-03-01
影响因子：
24
作者：
Nielsen, SL;Nygaard, H;Yoganathan, AP
通讯作者：
Yoganathan, AP
DOI：
10.1115/1.1500741
发表时间：
2002-10-01
影响因子：
1.7
作者：
Nielsen, SL;Nygaard, H;Yoganathan, AP
通讯作者：
Yoganathan, AP
影响因子：
37.8
作者：
He, SQ;Fontaine, AA;Levine, RA
通讯作者：
Levine, RA