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Baikoussis NG, Koumallos N, Aggeli Κ. Mitral valve repair with the use of the "Memo 3D ReChord" ring. J Cardiothorac Surg 2023; 18:151. [PMID: 37069590 PMCID: PMC10111840 DOI: 10.1186/s13019-023-02200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND From a variety of ring types, semirigid ring is more preferred for mitral annuloplasty during mitral valve repair particularly in patients whose native mitral saddle shape annulus is well maintained. During mitral annuloplasty artificial chord implantation with the appropriate neochord length is surgically challenging. We present our experience of using the Memo 3D ReChord, a semirigid ring with additional chordal guiding system for mitral valve repair. PATIENTS AND METHODS From September 2018 to February 2020, we successfully treated ten patients with severe (4+/4+) degenerative mitral valve regurgitation due to posterior leaflet prolapse with chordal rupture with the implantation Memo 3D ReChord and neo-chords. RESULTS We implanted from one to three neo-chords and always a ring in our patients. None of the patients had any residual mitral valve regurgitation at the end of the repair and on their discharge evaluated through transesophageal and transthoracic echocardiography respectively. There was no mortality at 30-days or on midterm follow-up. During the 3-month follow-up no regurgitation was noticed either. We included in our study only the patients successfully treated. We also used it in two patients, who underwent valve replacement during the same operation due to mild to moderate mitral valve regurgitation. CONCLUSIONS This, in our knowledge, is the first Greek series of the implantation of the Memo 3D Rechord. The initial excellent results give us the enthusiasm to continue while long-term results and the durability of this technique are necessary to establish this semirigid annuloplastic ring in our every-day practice.
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Affiliation(s)
- Nikolaos G Baikoussis
- Cardiac Surgery Department, Ippokrateio General Hospital of Athens, 114 Vasilissis Sofias Avenue, Athens, 11527, Greece.
| | - Nikolaos Koumallos
- Cardiac Surgery Department, Ippokrateio General Hospital of Athens, 114 Vasilissis Sofias Avenue, Athens, 11527, Greece
| | - Κonstantina Aggeli
- 1st Department of Cardiology, Ippokrateio General Hospital of Athens. Athens University, School of Medicine, Athens, Greece
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Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence. J Cardiovasc Dev Dis 2021; 8:jcdd8020009. [PMID: 33498935 PMCID: PMC7911536 DOI: 10.3390/jcdd8020009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
The morphological changes that occur in myxomatous mitral valve disease (MMVD) involve various components, ultimately leading to the impairment of mitral valve (MV) function. In this context, intrinsic mitral annular abnormalities are increasingly recognized, such as a mitral annular disjunction (MAD), a specific anatomical abnormality whereby there is a distinct separation between the mitral annulus and the left atrial wall and the basal portion of the posterolateral left ventricular myocardium. In recent years, several studies have suggested that MAD contributes to myxomatous degeneration of the mitral leaflets, and there is growing evidence that MAD is associated with ventricular arrhythmias and sudden cardiac death. In this review, the morphological characteristics of MAD and imaging tools for diagnosis will be described, and the clinical and functional aspects of the coincidence of MAD and myxomatous MVP will be discussed.
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Geometry of Tricuspid Valve Apparatus in Patients with Mitral Regurgitation due to Fibroelastic Deficiency versus Barlow Disease: A Real-Time Three-dimensional Transesophageal Echocardiography Study. J Am Soc Echocardiogr 2020; 33:1095-1105. [DOI: 10.1016/j.echo.2020.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
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Kagiyama N, Mondillo S, Yoshida K, Mandoli GE, Cameli M. Subtypes of Atrial Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2020; 13:820-835. [DOI: 10.1016/j.jcmg.2019.01.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 10/26/2022]
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Lee APW, Jin CN, Fan Y, Wong RH, Underwood MJ, Wan S. Functional Implication of Mitral Annular Disjunction in Mitral Valve Prolapse. JACC Cardiovasc Imaging 2017; 10:1424-1433. [DOI: 10.1016/j.jcmg.2016.11.022] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/01/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
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6
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Surkova E, Muraru D, Aruta P, Romeo G, Bidviene J, Cherata D, Badano LP. Current Clinical Applications of Three-Dimensional Echocardiography: When the Technique Makes the Difference. Curr Cardiol Rep 2017; 18:109. [PMID: 27628295 DOI: 10.1007/s11886-016-0787-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Advances in ultrasound, computer, and electronics technology have permitted three-dimensional echocardiography (3DE) to become a clinically viable imaging modality, with significant impact on patient diagnosis, management, and outcome. Thanks to the inception of a fully sampled matrix transducer for transthoracic and transesophageal probes, 3DE now offers much faster and easier data acquisition, immediate display of anatomy, and the possibility of online quantitative analysis of cardiac chambers and heart valves. The clinical use of transthoracic 3DE has been primarily focused, albeit not exclusively, on the assessment of cardiac chamber volumes and function. Transesophageal 3DE has been applied mostly for assessing heart valve anatomy and function. The advantages of using 3DE to measure cardiac chamber volumes derive from the lack of geometric assumptions about their shape and the avoidance of the apical view foreshortening, which are the main shortcomings of volume calculations from two-dimensional echocardiographic views. Moreover, 3DE offers a unique realistic en face display of heart valves, congenital defects, and surrounding structures allowing a better appreciation of the dynamic functional anatomy of cardiac abnormalities in vivo. Offline quantitation of 3DE data sets has made significant contributions to our mechanistic understanding of normal and diseased heart valves, as well as of their alterations induced by surgical or interventional procedures. As reparative cardiac surgery and transcatheter procedures become more and more popular for treating structural heart disease, transesophageal 3DE has expanded its role as the premier technique for procedure planning, intra-procedural guidance, as well as for checking device function and potential complications after the procedure.
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Affiliation(s)
- Elena Surkova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Internal Medicine, Samara State Medical University, Chapaevskaya Str. 89, 443099, Samara, Russian Federation
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
| | - Patrizia Aruta
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Gabriella Romeo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Jurate Bidviene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Diana Cherata
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Effect of aortic regurgitant jet direction on mitral valve leaflet remodeling: a real-time three-dimensional transesophageal echocardiography study. Sci Rep 2017; 7:8884. [PMID: 28827606 PMCID: PMC5567050 DOI: 10.1038/s41598-017-09252-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/19/2017] [Indexed: 01/06/2023] Open
Abstract
Chronic aortic regurgitation (AR) induces mitral valve (MV) leaflet enlargement, although, its mechanism still remains unclear. This study aimed to clarify the influence of AR jet directions on the MV apparatus in patients with chronic AR. This study included 69 consecutive patients with severe chronic AR and 17 controls who underwent three-dimensional (3D) transesophageal echocardiography (TEE). The anterior mitral leaflet (AML), posterior mitral leaflet (PML) and MV annulus areas were measured at mid-diastole. All AR patients were classified into the posterior (Group A, n = 38) or non-posterior (Group B, n = 31) group based on the AR jet directions. Both two groups revealed the increased total leaflet areas compared with the controls. No significant differences in the left ventricular volumes, PML or MV annulus area were observed between Group A and B; however, Group A had the larger AML area and greater AML/PML area ratio than Group B (both P < 0.01). The multivariate analysis indicated that the posterior AR jet was independently associated with the AML/PML area (P < 0.01). 3D TEE depicted geometric differences in the MV apparatus between the different types of AR jet directions. These results may be helpful in understanding the mechanism of MV leaflet remodeling in chronic AR.
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Jin CN, Salgo IS, Schneider RJ, Kam KKH, Chi WK, So CY, Tang Z, Wan S, Wong R, Underwood M, Lee APW. Using Anatomic Intelligence to Localize Mitral Valve Prolapse on Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29:938-945. [DOI: 10.1016/j.echo.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Indexed: 10/21/2022]
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Wan S, Lee AP, Attaran S, Yu PS, Au SS, Kwok MW, Lau RW, Wong RH, Wan IY, Ng SK, Underwood MJ. Mitral valve repair using a semirigid ring: patient selection and early outcomes. Asian Cardiovasc Thorac Ann 2016; 24:647-52. [PMID: 27448551 DOI: 10.1177/0218492316659970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. METHODS We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. RESULTS Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. CONCLUSIONS Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
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Affiliation(s)
- Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex Pw Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Saina Attaran
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter Sy Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sylvia Sw Au
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Micky Wt Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow Wh Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph Hl Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Yp Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Siu-Keung Ng
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Arribas-Jimenez A, Rama-Merchan JC, Barreiro-Pérez M, Merchan-Gómez S, Iscar-Galán A, Martín-García A, Nieto-Ballestero F, Sánchez-Corral E, Rodriguez-Collado J, Cruz-González I, Sanchez PL. Utility of Real-Time 3-Dimensional Transesophageal Echocardiography in the Assessment of Mitral Paravalvular Leak. Circ J 2016; 80:738-44. [PMID: 26823141 DOI: 10.1253/circj.cj-15-0802] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mitral paravalvular leak (PVL) is a potential complication of surgical valve replacement procedures. Real-time 3D transesophageal echocardiography (RT-3DTEE) has emerged as an efficient tool for providing essential information about the anatomy of mitral PVLs compared with 2DTEE findings. The purpose of this study was to evaluate the utility of RT-3DTEE in the assessment of mitral PVLs. METHODS AND RESULTS The 3D characteristics of PVLs were recorded and compared with 2D findings. We included 34 consecutive patients with clinical suspicion of mitral PVL in the study. Mitral PVLs were detected in 26 patients (76%); 26 PVLs were identified by 2DTEE and 37 by RT-3DTEE. Moderate or severe mitral regurgitation was present in 23 patients (88%). The most common PVL locations were the septal and posterior regions. The median PVL size measured by RT-3DTEE was 7 mm long×4 mm wide. The median vena contracta of defect measured by 2DTEE and RT-3DTEE was 5 mm and 4 mm, respectively. The median effective regurgitant orifice area of defect measured by RT-3DTEE was 0.36 cm(2). The defect types were "oval" (54%), "round" (35%), "crescentic" (8%) and highly irregular (3%). CONCLUSIONS Compared with 2DTEE, RT-3DTEE provided detailed descriptions of the number, location, size and morphology of PVLs, which is essential for planning and guiding the potential corrective techniques. (Circ J 2016; 80: 738-744).
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Kitahara H, Murata M, Okamoto K, Kudo M, Yoshitake A, Tsuruta H, Itabashi Y, Fukuda K, Yozu R, Shimizu H. Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique. Circ J 2016; 80:663-7. [DOI: 10.1253/circj.cj-15-0902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroto Kitahara
- Department of Cardiovascular Surgery, Keio University, School of Medicine
| | - Mitsushige Murata
- Department of Laboratory Medicine, Keio University, School of Medicine
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Keio University, School of Medicine
| | - Mikihiko Kudo
- Department of Cardiovascular Surgery, Keio University, School of Medicine
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University, School of Medicine
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University, School of Medicine
| | - Yuji Itabashi
- Department of Cardiology, Keio University, School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University, School of Medicine
| | - Ryohei Yozu
- Department of Cardiovascular Surgery, Keio University, School of Medicine
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, School of Medicine
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Kagiyama N, Toki M, Hara M, Fukuda S, Aritaka S, Miki T, Ohara M, Hayashida A, Hirohata A, Yamamoto K, Yoshida K. Efficacy and Accuracy of Novel Automated Mitral Valve Quantification: Three-Dimensional Transesophageal Echocardiographic Study. Echocardiography 2015; 33:756-63. [DOI: 10.1111/echo.13135] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nobuyuki Kagiyama
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Misako Toki
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Masahiko Hara
- Department of Medical Innovation; Osaka University Hospital; Osaka Japan
| | - Shuichiro Fukuda
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Shingo Aritaka
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Tomonori Miki
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Minako Ohara
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Akihiro Hayashida
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Atsushi Hirohata
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Keizo Yamamoto
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Kiyoshi Yoshida
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
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Jin CN, Salgo IS, Schneider RJ, Feng W, Meng FX, Kam KKH, Chi WK, So CY, Chan C, Sun JP, Tsui G, Wong KYK, Yu CM, Wan S, Wong R, Underwood M, Au S, Ng SK, Lee APW. Automated quantification of mitral valve anatomy using anatomical intelligence in three-dimensional echocardiography. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Abstract
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.
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Affiliation(s)
- Takahiro Shiota
- Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA
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