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Caracterización in vitro de los mecanismos responsables de la regurgitación funcional de la tricúspide
Erin M Spinner1, Patrick Shannon, Dana Buice
1Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
Circulation
|August 4, 2011
Resumen
La regurgitación tricúspide funcional (TR) puede ser el resultado de la dilatación anular o el desplazamiento del músculo papilar (PM). Ambos mecanismos causan TR, y las estrategias de reparación deben considerar el desplazamiento severo de PM.
Área de la Ciencia:
- Investigación Cardiovascular Investigación Cardiovascular Investigación Cardiovascular Investigación Cardiovascular Investigación Cardiovascular
- Mecánica cardíaca La mecánica cardíaca.
- Enfermedad Valvular del Corazón.
Sus antecedentes:
- La regurgitación tricúspide funcional (TR) es una causa significativa de morbilidad.
- La reparación actual de TR se centra en la remodelación anular debido a la dilatación anular común.
- El papel del desplazamiento del músculo papilar (MP) en la TR se entiende menos que en la regurgitación mitral.
Objetivo del estudio:
- Para investigar los mecanismos de TR causados por la dilatación anular.
- Para dilucidar la contribución del desplazamiento del músculo papilar (PM) al TR.
- Para comparar los efectos de la dilatación anular aislada y combinada y el desplazamiento de PM en la función de la válvula tricúspide.
Principales métodos:
- Utilizó un simulador in vitro del corazón derecho con 16 válvulas tricúspidas porcinas.
- Dinámica de válvula cuantificada bajo dilatación anular aislada (hasta el 100%).
- Efectos evaluados del desplazamiento del músculo papilar aislado y combinado (MP) y la dilatación anular.
Principales resultados:
- La incompetencia de la válvula tricúspide se produjo con una dilatación anular del 40%, causando un TR significativo (7,9 ± 3,4 mL).
- El desplazamiento aislado de PM, que afecta a la parte anterior, posterior / septal, o a todas las PM, aumentó significativamente el TR.
- Se observó una mala adaptación de los folletos, con el folleto anterior mostrando el mayor cambio en la longitud residual y el folleto septal mostrando una reducción con el desplazamiento de PM.
Conclusiones:
- La dilatación anular por sí sola puede causar regurgitación tricúspide funcional (TR).
- El desplazamiento del músculo papilar (MP) es una causa independiente de TR.
- Las estrategias de reparación de la válvula tricúspide deben adaptarse a los casos con desplazamiento severo de PM.
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