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J Thorac Cardiovasc Surg 2000;120:966-975
© 2000 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

The effects of ring annuloplasty on mitral leaflet geometry during acute left ventricular ischemia

From the Department of Cardiovascular and Thoracic Surgery^a and Division of Cardiovascular Medicine,^c Stanford University School of Medicine, Stanford, Calif, and the Laboratory of Cardiovascular Physiology and Biophysics,^b Research Institute of the Palo Alto Medical Foundation, Palo Alto, Calif.

This work was supported by grants HL-29589 and HL-48837 from the National Heart, Lung, and Blood Institute. Green and Dagum were supported by National Heart, Lung, and Blood Institute Individual Research Service Awards HL-09569 and HL-10000; Green, Dagum, Lai, and Glasson are Carl and Leah McConnell Cardiovascular Surgical Research Fellows. Glasson is also a Katharine McCormick Scholar. Glasson and Timek are recipients of Thoracic Surgery Education and Research Foundation Fellowship Awards.

Received for publication May 4, 2000. Revisions requested June 6, 2000; revisions received July 6, 2000. Accepted for publication July 14, 2000. Address for reprints: D. Craig Miller, MD, Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247 (E-mail: dcm{at}stanford.edu).

Abstract

Background: The perturbed mitral leaflet geometry that leads to acute ischemic mitral regurgitation during acute left ventricular ischemia has not been quantified, nor is it known whether annuloplasty rings affect these detrimental changes in leaflet geometry.
Methods: Radiopaque markers were implanted on both mitral leaflets and around the anulus in 3 groups of sheep: one group without rings served as the control group (n = 7); the others underwent Duran (n = 6; Medtronic Heart Valve Division, Minneapolis, Minn) or Carpentier-Edwards Physio (n = 5; Baxter Cardiovascular Division, Santa Ana, Calif) ring annuloplasty. After recovery, 3-dimensional marker coordinates were obtained by means of biplane videofluoroscopy before and during acute posterolateral left ventricular ischemia. Leaflet geometry was defined by measuring distances between annular and leaflet markers and perpendicular distances to the leaflet markers from a best-fit annular plane.
Results: In all control animals, left ventricular ischemia was associated with acute ischemic mitral regurgitation and apical displacement (away from the annular plane) of the posterior leaflet edge and base markers by 0.6 ± 0.4 mm (P = .01) and 0.7 ± 0.2 mm (P < .001), respectively. The distance between the posterior leaflet markers and the mid-posterior anulus did not change significantly during ischemia. The anterior leaflet edge marker extended 1.0 ± 0.5 mm (P = .01) away from the mid-anterior anulus during ischemia, but compared with its nonischemic position, the anterior leaflet was not displaced apically away from the annular plane. In all animals in the Duran and Physio groups, leaflet geometry was unchanged during ischemia, and acute ischemic mitral regurgitation was not detected.
Conclusion: Acute ischemic mitral regurgitation was associated with restricted motion of the posterior leaflet and extension of the anterior leaflet. Annuloplasty rings prevented these geometric perturbations of the mitral leaflets during acute left ventricular ischemia and preserved valvular competence.

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