Undersized mitral annuloplasty inhibits left ventricular basal wall thickening but does not affect equatorial wall cardiac strains 3rd Biennial Meeting of Society-for-Heart-Valve-Disease Cheng, A., Nguyen, T. C., Malinowski, M., Liang, D., Daughters, G. T., Ingels, N. B., Miller, D. C. I C R PUBLISHERS. 2007: 349–58


Undersized mitral annuloplasty has been widely employed for patients with ischemic mitral regurgitation. Beyond correction of mitral regurgitation, ring annuloplasty is postulated to normalize global left ventricular (LV) shape, thereby decreasing LV wall stress and promoting reverse LV remodeling. The effect of undersized annuloplasty on regional transmural LV wall thickening and strain patterns, however, has not been examined.In nine sheep, transmural radiopaque beadsets were inserted into the anterobasal and equatorial lateral LV walls, with additional markers silhouetting the left ventricle and mitral annulus. Four-dimensional marker dynamics were studied with biplane videofluoroscopy (open-chest) before and after tightening a Paneth-type mitral annuloplasty suture. LV volumes, mitral dimensions, transmural circumferential, longitudinal, and radial systolic strains, and end-diastolic (ED) and end-systolic (ES) remodeling strains in the two LV regions were computed.In the anterobasal LV wall close to the mitral annulus, annuloplasty increased ED wall thickness and surprisingly reduced systolic radial strain (wall thickening) at all transmural depths. Radial subepicardial, midwall, and subendocardial wall-thickening strains at ES in the anterobasal LV site were 0.25 +/- 0.15, 0.33 +/- 0.16, and 0.47 +/- 0.29, respectively, before tightening the suture annuloplasty, compared to 0.13 +/- 0.12, 0.15 +/- 0.18, and 0.20 +/- 0.26 after tightening. In the equatorial lateral LV wall further away from the annulus, most LV transmural systolic and remodeling strains did not change.Simulated undersized annuloplasty acutely decreased transmural systolic LV wall thickening in the anterobasal region, without substantially affecting transmural deformations in the lateral LV wall. These acute effects of undersized annuloplasty require a better understanding as they may potentially be deleterious, and a direct ventricular approach may be needed as an adjunct to promote reverse LV remodeling.

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