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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
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Efficacy of chordal cutting to relieve chronic persistent ischemic mitral regurgitation

Emmanuel Messas1, Bruno Pouzet, Bernard Touchot

  • 1Faculté de Médecine Necker-Enfants Malades, INSERM EMI-0016, Ecole de Chirurgie, Assistance Publique - Hôpitaux de Paris, Service de Cardiologie 1 et de Chirurgie Cardio -Vasculaire, Hôpital Européen Georges Pompidou, Paris, France.

Circulation
|September 13, 2003
PubMed
Abstract

Insights

Cutting specific heart valve cords effectively treats chronic ischemic mitral regurgitation without negative effects. This minimally invasive procedure improves heart function and reduces mitral regurgitation in patients with ischemic heart disease.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Mechanics
  • Heart Valve Disease

Background:

  • Mitral regurgitation (MR) is a common complication of ischemic heart disease, often inadequately treated by standard methods due to leaflet tethering.
  • Chordal tethering to displaced papillary muscles restricts leaflet closure, leading to persistent MR despite left ventricular (LV) remodeling.
  • Previous acute models showed promise for chordal cutting to reduce MR, but efficacy in chronic conditions with advanced remodeling was unknown.

Purpose of the Study:

  • To evaluate the effectiveness of cutting specific basal chordae in reducing chronic persistent ischemic mitral regurgitation (MR) in a sheep model.
  • To assess the impact of this intervention on left ventricular (LV) function, valve geometry, and the incidence of prolapse or recurrent MR.
  • To determine the long-term safety and efficacy of chordal cutting in chronic ischemic MR.

Main Methods:

  • Seven sheep with chronic inferobasal infarcts and progressive MR underwent cutting of the two central basal chordae at the leaflet base.
  • 3-Dimensional echocardiography was used to quantify MR severity, LV function (ejection fraction), and valve geometry before and after the procedure.
  • Five additional sheep were followed long-term after inferobasal infarction and chordal cutting to assess sustained effects.

Main Results:

  • Cutting the central basal chordae significantly reduced MR in all 7 sheep, restoring it to baseline levels (regurgitant fraction decreased significantly, P<0.0001).
  • The procedure effectively improved leaflet coaptation without causing valve prolapse or a decline in LV ejection fraction (EF) (41.1% to 42.6%, P=NS).
  • Long-term follow-up in 5 sheep showed no evidence of prolapse or recurrent MR, and no significant decrease in post-infarct LVEF.

Conclusions:

  • A minimally invasive approach of cutting a few basal chordae effectively reduces chronic persistent ischemic MR by improving leaflet coaptation.
  • This technique offers a promising therapeutic option for ischemic MR without compromising LV ejection fraction or causing adverse valve events.
  • Chordal cutting is safe and effective long-term, even when performed after significant LV remodeling due to infarction.

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