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Efectos de la annuloplastia mitral de tamaño insuficiente en las cepas regionales de la pared ventricular izquierda

Allen Cheng¹, Tom C Nguyen, Marcin Malinowski

¹Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305-5247, USA.

|July 6, 2006

Resumen

La annuloplastia mitral de menor tamaño redujo el engrosamiento de la pared sistólica en la región anterobasal al deteriorar el acortamiento de la fibra y el engrosamiento de la lámina. Este procedimiento puede tener un impacto negativo en la mecánica local del miocardio, especialmente cerca del anillo mitral.

Área de la Ciencia:

Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
Ingeniería Biomédica Ingeniería Biomédica.
Mecánica cardíaca La mecánica cardíaca.

Sus antecedentes:

La annuloplastia mitral de menor tamaño se utiliza para la regurgitación mitral (MR) y tiene como objetivo mejorar la forma del ventrículo izquierdo (LV).
Estudios previos sugieren que puede inhibir el engrosamiento de la pared sistólica cerca del anillo mitral.
Este estudio investiga los efectos en la mecánica de las paredes regionales transmurales de LV.

Objetivo del estudio:

Para medir los efectos de la annuloplastia mitral de tamaño insuficiente en las cepas regionales de fibra de pared y láminas transmurales de LV.
Para analizar los mecanismos de engrosamiento de la pared sistólica después de la annuloplasty.

Principales métodos:

Nueve ovejas se sometieron a la inserción quirúrgica de conjuntos de cuentas radiopacas en las regiones de LV anterobasal y lateral ecuatorial.
La videofluoroscopia en 4 dimensiones rastreó la dinámica de los marcadores antes y después de la anuloplastia mitral.
Se calcularon las cepas transmurales (circumferenciales, longitudinales, radiales) y se transformaron en coordenadas de fibra, hoja y hoja normal.

Principales resultados:

La annuloplastia insuficiente redujo el engrosamiento de la pared sistólica anterobasal en más del 50% en todas las profundidades.
Esta reducción se debió al acortamiento inhibido de la fibra subendocárdica y al engrosamiento de la lámina sistólica.
No se observaron cambios significativos en las cepas de la lámina de fibra o el engrosamiento de la pared en la región ecuatorial lateral remota.

Conclusiones:

La annuloplastia mitral de tamaño insuficiente inhibe agudamente el engrosamiento de la pared sistólica en la región de LV anterobasal.
La inhibición es el resultado de la reducción del acortamiento de la fibra subendocárdica y el engrosamiento de la lámina laminar.
Estos hallazgos sugieren efectos potencialmente perjudiciales de la annuloplastia de tamaño insuficiente en la mecánica local del miocardio.

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