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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Characterization of mitral valve anterior leaflet perfusion patterns
Julia C Swanson1, Lauren R Davis, Koji Arata
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5247, USA.
The Journal of Heart Valve Disease
|January 27, 2010
Summary
The ovine anterior mitral leaflet (AML) is perfused by vessels originating from the mid- and distal left circumflex artery (LCx), running through chordae tendineae and annulus. This vascular network may be crucial for valve health.
Area of Science:
- Cardiovascular Anatomy
- Vascular Biology
- Cardiac Physiology
Background:
- Histologic studies confirm blood vessels in the anterior mitral leaflet (AML) and second-order chordae (SC).
- The specific pattern and source of AML perfusion remain largely unknown.
- Understanding mitral valve perfusion is critical for diagnosing and treating valve disease.
Purpose of the Study:
- To investigate the pattern and source of anterior mitral leaflet (AML) perfusion.
- To elucidate the vascular supply to the mitral valve in an ovine model.
- To identify potential implications of microvascular dysfunction in mitral valve disease.
Main Methods:
- Utilized fluorescein angiography in 17 ovine hearts post-cardioplegic arrest.
- Administered non-selective left coronary artery (LCA) and selective left anterior descending (LAD), proximal, mid-, and distal left circumflex (LCx) perfusions.
- Obtained serial photographs via left atriotomy using a specialized flash/filter system for optimal fluorescence visualization.
Main Results:
- The proximal AML demonstrated rich vascularization.
- A consistent vascular loop was observed in the mitral annulus and AML, extending to SC insertion sites.
- Perfusion of the mid- and distal LCx arteries successfully supplied the AML via SC insertions and annular branches, unlike LAD or proximal LCx perfusion.
Conclusions:
- The ovine AML receives perfusion from vessels within the SC and annulus, forming an anastomotic arcade originating from the mid- and distal LCx.
- Disruptions in this vascular network due to microvascular disease may have significant adverse effects on mitral valve function.
- The extensive vascular component of the mitral valve plays a vital role, and its derangements could contribute to valve pathology.
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