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Influencia del folleto mitral anterior de segundo orden chordae tendineae en la función sistólica del ventrículo
Sten Lyager Nielsen1, Tomasz A Timek, G Randall Green
1Department of Cardiothoracic and Vascular Surgery and Institute of Experimental Clinical Research, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark.
Circulation
|July 16, 2003
Resumen
La ruptura de los cordones tendinosos anteriores en ovejas afectó agudamente la función sistólica ventricular izquierda (VL) regional cerca de los sitios de inserción. Esto pone de relieve los riesgos potenciales de los procedimientos de corte de chordae para la regurgitación mitral en los ventrículos comprometidos.
Área de la Ciencia:
- Fisiología cardiovascular fisiología cardiovascular.
- Mecánica cardíaca La mecánica cardíaca.
- Innovación quirúrgica en cirugía.
Sus antecedentes:
- El papel del folleto mitral anterior de segundo orden chordae tendineae en la mecánica sistólica del ventrículo izquierdo (LV) sigue siendo objeto de debate.
- Comprender esta contribución es crucial para desarrollar tratamientos efectivos para las afecciones cardíacas.
Objetivo del estudio:
- Cuantificar la contribución in vivo de las chordae tendineae anteriores (ACT) y las chordae tendineae posteriores (PCT) a la función contráctil LV regional y global.
- Para evaluar los efectos agudos de cortar estos chordae en la mecánica de LV.
Principales métodos:
- Se implantaron marcadores radiopacos en el epicardio LV de las ovejas para definir 12 regiones.
- Transductores de fuerza en microminiatura midieron la tensión cordal en ACT y PCT.
- Los datos hemodinámicos y la función regional (Fractional Area Shrinkage, r-PRSW) se registraron antes y después del corte de chordae (CUT).
Principales resultados:
- La función sistólica global de LV no se vio afectada después del CUT.
- El encogimiento de área fraccionada (FAS) disminuyó en segmentos de LV cerca de los sitios de inserción de PCT.
- Regional-PRSW (r-PRSW) disminuyó significativamente cerca de los sitios de inserción de ACT y PCT.
- Los cordones tendinosos posteriores (PCT) exhibieron una tensión máxima más alta que los cordones tendinosos anteriores (ACT).
Conclusiones:
- La división aguda de los chordales del estruendo del prospecto anterior dio lugar a una disfunción sistólica regional de LV en los sitios de inserción de la cuerda.
- Los procedimientos que implican el corte de chordae de segundo orden requieren precaución, especialmente en los ventrículos con deterioro preexistente.
- Estos hallazgos sugieren un posible compromiso de la función sistólica de LV después de tales intervenciones.
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