61
Strain balance of papillary muscles after mitral valve repair
25. Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 1988;11:1010 –9. 26. Nguyen TC, Cheng A, Tibayan FA, Liang D, Daughters GT, Ingels NBJr et al. Septallateral annular cinching perturbs basal left ventricular transmural strains. Eur J Cardiothorac Surg 2007;31:423–9. 27. Lai DT, Timek TA, Tibayan FA, Green GR, Daughters GT, Liang D et al. The effects of mitral annuloplasty rings on mitral valve complex 3D geometry during acute left ventricular ischemia. Eur J Cardiovasc Surg 2002;22:808 –16. 28. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet 2009;373: 1382– 94. 29. Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation 2006;18: 2238– 44. 30. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J 2010;31:1958 –66. 31. Zegdi R, Sleilaty G, Latre´mouille C, Berrebi A, Carpentier A, Deloche A et al. Reoperation for failure of mitral valve repair in degenerative disease: a single center experience. Ann Thorac Surg 2008;86:1480 –4.
32. He Z, Ritchie J, Grashow JS, Sacks MS, Yoganathan AP. In vitro dynamic strain behavior of the mitral valve posterior leaflet. J Biomech Eng 2005;127:504 –11. 33. He Z, Sacks MS, Baijens L, Wanant S, Shah P, Yoganathan AP. Effects of papillary muscle position on in-vitro dynamic strain on the porcine mitral valve. J Heart Valve Dis 2003;12:488 –94. 34. Jensen AS, Baandrup U, Hasenkam JM, Kundu T, Jorgensen CS. Distribution of the microelastic properties within the human anterior mitral leaflet. Ultrasound Med Biol 2006;32:1943 –8. 35. DiPalma JR, Reiss RA. The mechanics of Starling’s law of the heart. Fed Proc 1948;7:28. 36. Pandis D, Grapsa J, Athanasiou T, Punjabi P, Nihoyannopoulos P. Left ventricular remodeling and mitral valve surgery: prospective study with real-time 3-dimensional echocardiography and speckle tracking. J Thorac Cardiovasc Surg 2011;142:641 – 9. 37. Grapsa J, Dawson D, Pandis D, Ntalarizou E, Cheung WS, Efthimiadis I et al. Mitral valve repair results in better right ventricular remodelling than valve replacement for degenerative mitral regurgitation: a three-dimensional echocardiographic study. Hellenic J Cardiol 2012;53:279 –86. 38. Tigen K, Karaahmet T, Dundar C, Guler A, Cevik C, Basaran O et al. The importance of papillary muscle dyssynchrony in predicting the severity of functional mitral regurgitation in patients with non-ischaemic dilated cardiomyopathy: a two-dimensional speckle-tracking echocardiography study. Eur J Echocardiogr 2010;11:671–6.
IMAGE FOCUS
doi:10.1093/ehjci/jeu152 Online publish-ahead-of-print 22 August 2014
.............................................................................................................................................................................
Prosthetic aortic valve stenosis secondary to non-optimal surgical suture Fausto Pizzino1, Giampiero Vizzari1, and Bijoy K. Khandheria2*
* Corresponding author. Tel: +1 4146493909; Fax: +1 4146493551. Email: [email protected]
A 73-year-old male came to the emergency department with a mildly increased troponin I level (0.28 ng/mL) and normal electrocardiogram complaining of dyspnoea after having chest and back pain a few hours before. The patient had a past medical history of Type 2 diabetes mellitus, dyslipidaemia, and hypertension. Nine months before he had had three coronary bypasses and aortic valve replacement for aortic stenosis. The transthoracic echocardiogram revealed an increased aortic gradient of 70 mmHg with a functional area of 0.6 cm2. The transoesophageal echocardiogram confirmed the presence of a prosthetic 3-leaflet aortic valve with very poor leaflet motion and elevated aortic gradient; neither vegetation nor thrombus was noted (Panels A–C and see Supplementary data online, Videos S1–S3). The aortotomy performed in the operating room revealed diffuse and severe atherosclerosis in the ascending aorta, mostly located at the sinotubular junction. The aortic valve had a polypropylene purse-string suture around the apex of the struts of the valve and tied. It appears the valve was sewn-in using an endoscopic suturing device. Prosthetic leaflets appeared stuck, thickened and covered by abundant pannus. The metal clips were removed, then the valve was debrided and excised without difficulty. The new prosthetic valve was easily seated and tied, the aorta was then closed in two layers and a warm dose of retrograde cardioplegia was administered. The post-pump transoesophageal echocardiogram showed preservation of left ventricular function, a normally functioning bio-prosthetic valve and the absence of perivalvular leaks or transvalvular regurgitation (Panel D and see Supplementary data online, Video S4). Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on November 14, 2015
1 Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria ‘Policlinico G. Martino’ and Universita’ degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy and 2Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee WI 53215, USA
Strain balance of papillary muscles after mitral valve repair
25. Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 1988;11:1010 –9. 26. Nguyen TC, Cheng A, Tibayan FA, Liang D, Daughters GT, Ingels NBJr et al. Septallateral annular cinching perturbs basal left ventricular transmural strains. Eur J Cardiothorac Surg 2007;31:423–9. 27. Lai DT, Timek TA, Tibayan FA, Green GR, Daughters GT, Liang D et al. The effects of mitral annuloplasty rings on mitral valve complex 3D geometry during acute left ventricular ischemia. Eur J Cardiovasc Surg 2002;22:808 –16. 28. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet 2009;373: 1382– 94. 29. Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation 2006;18: 2238– 44. 30. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J 2010;31:1958 –66. 31. Zegdi R, Sleilaty G, Latre´mouille C, Berrebi A, Carpentier A, Deloche A et al. Reoperation for failure of mitral valve repair in degenerative disease: a single center experience. Ann Thorac Surg 2008;86:1480 –4.
32. He Z, Ritchie J, Grashow JS, Sacks MS, Yoganathan AP. In vitro dynamic strain behavior of the mitral valve posterior leaflet. J Biomech Eng 2005;127:504 –11. 33. He Z, Sacks MS, Baijens L, Wanant S, Shah P, Yoganathan AP. Effects of papillary muscle position on in-vitro dynamic strain on the porcine mitral valve. J Heart Valve Dis 2003;12:488 –94. 34. Jensen AS, Baandrup U, Hasenkam JM, Kundu T, Jorgensen CS. Distribution of the microelastic properties within the human anterior mitral leaflet. Ultrasound Med Biol 2006;32:1943 –8. 35. DiPalma JR, Reiss RA. The mechanics of Starling’s law of the heart. Fed Proc 1948;7:28. 36. Pandis D, Grapsa J, Athanasiou T, Punjabi P, Nihoyannopoulos P. Left ventricular remodeling and mitral valve surgery: prospective study with real-time 3-dimensional echocardiography and speckle tracking. J Thorac Cardiovasc Surg 2011;142:641 – 9. 37. Grapsa J, Dawson D, Pandis D, Ntalarizou E, Cheung WS, Efthimiadis I et al. Mitral valve repair results in better right ventricular remodelling than valve replacement for degenerative mitral regurgitation: a three-dimensional echocardiographic study. Hellenic J Cardiol 2012;53:279 –86. 38. Tigen K, Karaahmet T, Dundar C, Guler A, Cevik C, Basaran O et al. The importance of papillary muscle dyssynchrony in predicting the severity of functional mitral regurgitation in patients with non-ischaemic dilated cardiomyopathy: a two-dimensional speckle-tracking echocardiography study. Eur J Echocardiogr 2010;11:671–6.
IMAGE FOCUS
doi:10.1093/ehjci/jeu152 Online publish-ahead-of-print 22 August 2014
.............................................................................................................................................................................
Prosthetic aortic valve stenosis secondary to non-optimal surgical suture Fausto Pizzino1, Giampiero Vizzari1, and Bijoy K. Khandheria2*
* Corresponding author. Tel: +1 4146493909; Fax: +1 4146493551. Email: [email protected]
A 73-year-old male came to the emergency department with a mildly increased troponin I level (0.28 ng/mL) and normal electrocardiogram complaining of dyspnoea after having chest and back pain a few hours before. The patient had a past medical history of Type 2 diabetes mellitus, dyslipidaemia, and hypertension. Nine months before he had had three coronary bypasses and aortic valve replacement for aortic stenosis. The transthoracic echocardiogram revealed an increased aortic gradient of 70 mmHg with a functional area of 0.6 cm2. The transoesophageal echocardiogram confirmed the presence of a prosthetic 3-leaflet aortic valve with very poor leaflet motion and elevated aortic gradient; neither vegetation nor thrombus was noted (Panels A–C and see Supplementary data online, Videos S1–S3). The aortotomy performed in the operating room revealed diffuse and severe atherosclerosis in the ascending aorta, mostly located at the sinotubular junction. The aortic valve had a polypropylene purse-string suture around the apex of the struts of the valve and tied. It appears the valve was sewn-in using an endoscopic suturing device. Prosthetic leaflets appeared stuck, thickened and covered by abundant pannus. The metal clips were removed, then the valve was debrided and excised without difficulty. The new prosthetic valve was easily seated and tied, the aorta was then closed in two layers and a warm dose of retrograde cardioplegia was administered. The post-pump transoesophageal echocardiogram showed preservation of left ventricular function, a normally functioning bio-prosthetic valve and the absence of perivalvular leaks or transvalvular regurgitation (Panel D and see Supplementary data online, Video S4). Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on November 14, 2015
1 Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria ‘Policlinico G. Martino’ and Universita’ degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy and 2Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee WI 53215, USA
