Reverse ventricular remodeling reduces ischemic mitral regurgitation: echo-guided device application in the beating
Judy Hung1, J Luis Guerrero, Mark D Handschumacher
1Cardiac Ultrasound Laboratory and Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
Circulation
|November 13, 2002
Summary
Echocardiography-guided repositioning of papillary muscles (PMs) effectively reduced ischemic mitral regurgitation (MR) in sheep. This novel technique improved MR without negatively impacting left ventricular (LV) function, offering a new therapeutic approach.
Area of Science:
- Cardiovascular Science
- Medical Devices
- Echocardiography
Background:
- Ischemic mitral regurgitation (MR) involves restricted leaflet closure due to ventricular remodeling and papillary muscle (PM) displacement.
- Current therapies like ring annuloplasty are limited as they don't address PM displacement.
- The effectiveness of PM repositioning for MR treatment remains uncertain.
Purpose of the Study:
- To test the hypothesis that echocardiography-guided PM repositioning using an external device can reduce MR.
- To evaluate if this technique compromises left ventricular (LV) function.
- To assess the feasibility of this approach in a beating heart model.
Main Methods:
- 10 sheep with induced ischemic MR underwent PM repositioning using an external Dacron patch with an inflatable balloon under echocardiography guidance.
- 3D echocardiography assessed mitral valve geometry.
- Sonomicrometry, Millar catheters, and microspheres evaluated LV function and coronary flow.
Main Results:
- Echo-guided PM repositioning significantly decreased PM tethering distance.
- Moderate MR resolved after the procedure.
- Left ventricular contractility and end-diastolic pressure remained unchanged, with no reduction in coronary flow to noninfarcted regions.
Conclusions:
- An external device for PM repositioning can successfully reduce ischemic MR.
- The technique does not compromise LV function.
- This simple, echo-guided method is applicable in a beating heart setting.
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