How and where the mitral valve leaks in functional mitral regurgitation
Background and Aim: It remains unknown how and where the mitral valve leaks in functional mitral regurgitation. The objective of the current study was to quantify the geometry and position of the leaflet free edges in order to reveal gapping mechanism of the mitral valve, and develop a plug techniqu...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2019-06-01
|
Series: | Medicine in Novel Technology and Devices |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2590093519300177 |
id |
doaj-1718e384b21f499c8e94650f3c8f92b7 |
---|---|
record_format |
Article |
spelling |
doaj-1718e384b21f499c8e94650f3c8f92b72020-11-25T03:01:35ZengElsevierMedicine in Novel Technology and Devices2590-09352019-06-012100017How and where the mitral valve leaks in functional mitral regurgitationZhongxi Zhou0Bo Gao1Teng Jing2Stephanie Wang3Shamini Parameswaran4Zhaoming He5Research Center of Fluid Machinery Engineering & Technology, Jiangsu University, Zhenjiang, Jiangsu Province, 212013, PR ChinaDepartment of Mechanical Engineering, Texas Tech University, Lubbock, TX, 79409, USAResearch Center of Fluid Machinery Engineering & Technology, Jiangsu University, Zhenjiang, Jiangsu Province, 212013, PR ChinaSeven Lakes High School, Katy, TX, 77494, USADivision of Cardiothoracic Surgery, Yale University, New Haven, CT, 06519, USADepartment of Mechanical Engineering, Texas Tech University, Lubbock, TX, 79409, USA; Corresponding author. Department of Mechanical Engineering, Texas Tech University, 2703 7th street, PO Box 41021, Lubbock, TX, 79409-1021, USA.Background and Aim: It remains unknown how and where the mitral valve leaks in functional mitral regurgitation. The objective of the current study was to quantify the geometry and position of the leaflet free edges in order to reveal gapping mechanism of the mitral valve, and develop a plug technique to prevent mitral regurgitation. Methods: Eight porcine mitral valves were sutured onto a dilated annulus in an in-vitro experiment to simulate valve closure at hydrostatic transmitral pressure. Eight sonocrystals were attached to the mitral valve leaflet free edges. Papillary muscles (PM) were adjusted to the normal position, and subsequently to positions of asymmetric and symmetric papillary muscle displacement. Sonocrystal positions were measured and analyzed. Results: The leaflet free edges in the central and medial regions moved medially, apically, and posteriorly from normal to asymmetric PM position. Gapping potential in the posteromedial region increased. Medial displacement of the free edges sometimes generated a gap in the anterolateral region in the asymmetric PM position. The leaflet free edges moved posteriorly and apically from the normal to symmetric PM position, and generated a dumb-bell shaped gap. Conclusions: Asymmetric PM position impairs the posteromedial coaptation region due to leaflet tenting, and compromises the anterolateral coaptation region due to medial leaflet displacement. The gaps include multiple sites along the coaptation line. Symmetric PM position impairs valve coaptation due to valve tenting only. The gap is a symmetrical dumb-bell shape. The findings are crucial for development of the plug technique to prevent mitral regurgitation.http://www.sciencedirect.com/science/article/pii/S2590093519300177Mitral valvePlug techniqueGapping mechanismIschemic disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zhongxi Zhou Bo Gao Teng Jing Stephanie Wang Shamini Parameswaran Zhaoming He |
spellingShingle |
Zhongxi Zhou Bo Gao Teng Jing Stephanie Wang Shamini Parameswaran Zhaoming He How and where the mitral valve leaks in functional mitral regurgitation Medicine in Novel Technology and Devices Mitral valve Plug technique Gapping mechanism Ischemic disease |
author_facet |
Zhongxi Zhou Bo Gao Teng Jing Stephanie Wang Shamini Parameswaran Zhaoming He |
author_sort |
Zhongxi Zhou |
title |
How and where the mitral valve leaks in functional mitral regurgitation |
title_short |
How and where the mitral valve leaks in functional mitral regurgitation |
title_full |
How and where the mitral valve leaks in functional mitral regurgitation |
title_fullStr |
How and where the mitral valve leaks in functional mitral regurgitation |
title_full_unstemmed |
How and where the mitral valve leaks in functional mitral regurgitation |
title_sort |
how and where the mitral valve leaks in functional mitral regurgitation |
publisher |
Elsevier |
series |
Medicine in Novel Technology and Devices |
issn |
2590-0935 |
publishDate |
2019-06-01 |
description |
Background and Aim: It remains unknown how and where the mitral valve leaks in functional mitral regurgitation. The objective of the current study was to quantify the geometry and position of the leaflet free edges in order to reveal gapping mechanism of the mitral valve, and develop a plug technique to prevent mitral regurgitation. Methods: Eight porcine mitral valves were sutured onto a dilated annulus in an in-vitro experiment to simulate valve closure at hydrostatic transmitral pressure. Eight sonocrystals were attached to the mitral valve leaflet free edges. Papillary muscles (PM) were adjusted to the normal position, and subsequently to positions of asymmetric and symmetric papillary muscle displacement. Sonocrystal positions were measured and analyzed. Results: The leaflet free edges in the central and medial regions moved medially, apically, and posteriorly from normal to asymmetric PM position. Gapping potential in the posteromedial region increased. Medial displacement of the free edges sometimes generated a gap in the anterolateral region in the asymmetric PM position. The leaflet free edges moved posteriorly and apically from the normal to symmetric PM position, and generated a dumb-bell shaped gap. Conclusions: Asymmetric PM position impairs the posteromedial coaptation region due to leaflet tenting, and compromises the anterolateral coaptation region due to medial leaflet displacement. The gaps include multiple sites along the coaptation line. Symmetric PM position impairs valve coaptation due to valve tenting only. The gap is a symmetrical dumb-bell shape. The findings are crucial for development of the plug technique to prevent mitral regurgitation. |
topic |
Mitral valve Plug technique Gapping mechanism Ischemic disease |
url |
http://www.sciencedirect.com/science/article/pii/S2590093519300177 |
work_keys_str_mv |
AT zhongxizhou howandwherethemitralvalveleaksinfunctionalmitralregurgitation AT bogao howandwherethemitralvalveleaksinfunctionalmitralregurgitation AT tengjing howandwherethemitralvalveleaksinfunctionalmitralregurgitation AT stephaniewang howandwherethemitralvalveleaksinfunctionalmitralregurgitation AT shaminiparameswaran howandwherethemitralvalveleaksinfunctionalmitralregurgitation AT zhaominghe howandwherethemitralvalveleaksinfunctionalmitralregurgitation |
_version_ |
1724693094608142336 |