Mitral leaflet geometry pertubations with papillary muscle displacement and annular dilatation: An in-vitro study of ischemic mitral regurgitation

Shengqiu He, Jorge Jimenez, Zhaoming He, Ajit P. Yoganathan

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Background and aim of the study: Perturbations of leaflet geometry are the final end point through which left ventricular (LV) ischemia causes incomplete mitral leaflet closure and resultant mitral regurgitation (MR). Geometric inconsistencies observed with valvular or subvalvular structural alterations raise several questions. Methods: A new in-vitro LV flexible bag model was developed in order to visualize and analyze leaflet geometric changes under simulated pathological ischemic MR conditions. Results: Papillary muscle (PM) displacement and annular dilatation decreased leaflet coaptation length, leading to significant MR. Symmetrical PM displacement shifted the coaptation line towards the leaflet edges and created central gaps along this line. Asymmetric PM displacement generated diametrically uneven coaptation with a tent-shaped leaflet at the tethered PM side, while the leaflet bulged at the opposite side towards the left atrium. Conclusion: Leaflet geometry during systole is affected by subvalvular structures. Asymmetric PM displacement, which may occur in regional or acute myocardial infarction, induces irregular deformation of the leaflet's coaptation line and, as a result, MR at the tethered side. Direct visualization of leaflet perturbation under these simulated pathological conditions may promote understanding of mechanisms present in ischemic MR.

Original languageEnglish
Pages (from-to)300-307
Number of pages8
JournalJournal of Heart Valve Disease
Volume12
Issue number3
StatePublished - May 2003

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