ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Paul A. Spence
Charles M. Peniston
Tirone E. David
Tomas A. Salerno
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Spence, P. A.
Right arrow Articles by Salerno, T. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Spence, P. A.
Right arrow Articles by Salerno, T. A.

Ann Thorac Surg 1986;41:363-371
© 1986 The Society of Thoracic Surgeons

Articles

Toward a Better Understanding of the Etiology of Left Ventricular Dysfunction after Mitral Valve Replacement: An Experimental Study with Possible Clinical Implications

Paul A. Spence, M.D., Charles M. Peniston, M.D., Tirone E. David, M.D., Nick Mihic, M.D., A. Karim Jabr, C.P., P. Narini, Tomas A. Salerno, M.D.*

Divisions of Cardiovascular Surgery, St. Michael's Hospital and Toronto Western Hospital, University of Toronto, Toronto, Canada

Accepted for publication June 1, 1985.

* Address reprint requests to Dr. Salerno, Division of Cardiovascular Surgery, St. Michael's Hospital, 30 Bond St, Toronto, Ont, Canada M5B 1W8

The relatively high morbidity and mortality of mitral valve replacement (MVR) appears to be related to an impairment in left ventricular (LV) function. This two-part investigation was designed to assess the effect of MVR on global LV function in an isolated heart preparation and to evaluate whether a mitral prosthesis with a flexible annulus would be of benefit. In Part I (14 pigs), the effects of each step in MVR were studied. Division of the chordae tendineae caused a severe deterioration in LV function (systolic pressure, 180 ± 13 versus 120 ± 10 mm Hg; p < 0.05; developed pressure, 167 ± 13 versus 108 ± 11 mm Hg; p < 0.05; first derivative of LV pressure [dP/dt], 2,630 ± 300 versus 1,610 ± 180 mm Hg/sec; p < 0.05; balloon volume, 30 ml). Fixation of the mitral annulus prior to division of the chordae tendineae resulted in a small decrease (not significant) in LV function but had no effect after the chordae tendineae were divided. In Part II (10 pigs), two mitral annular prostheses were studied: a standard rigid prosthesis and a prosthesis of identical size but with a flexible annulus. LV function was better with the flexible than the rigid prosthesis (systolic pressure, 118 ± 10 versus 89 ± 5% control, p < 0.02; developed pressure, 120 ± 11 versus 87 ± 5% control; p < 0.02; dP/dt, 119 ± 10 versus 85 ± 4% control; p < 0.02; balloon volume, 30 ml). These results demonstrate that MVR causes a profound deterioration in LV function, a deterioration primarily due to division of the chordae tendineae. Fixation of the mitral annulus with a rigid prosthesis may also be an important cause of LV dysfunction.




This article has been cited by other articles:


Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
P. Fundaro, P. M. Tartara, E. Villa, P. Fratto, S. Campisi, and E. O. Vitali
Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty?
Asian Cardiovascular and Thoracic Annals, August 1, 2007; 15(4): 351 - 358.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
B.-C. Chang, Y.-N. Youn, J.-W. Ha, S.-H. Lim, Y.-S. Hong, and N. Chung
Long-term clinical results of mitral valvuloplasty using flexible and rigid rings: A prospective and randomized study
J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 995 - 1003.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. D. Accola, M. L. Scott, P. A. Thompson, G. J. Palmer III, M. E. Sand, and G. Ebra
Midterm Outcomes Using the Physio Ring in Mitral Valve Reconstruction: Experience in 492 Patients
Ann. Thorac. Surg., April 1, 2005; 79(4): 1276 - 1283.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. A. Borger, T. M. Yau, V. Rao, H. E. Scully, and T. E. David
Reoperative mitral valve replacement: importance of preservation of the subvalvular apparatus
Ann. Thorac. Surg., November 1, 2002; 74(5): 1482 - 1487.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
j. Cross
The Economics of Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1999; 3(4): 227 - 230.
[Abstract] [PDF]

Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
M. Kestelli, R. Zeybek, G. Onem, E. Tonguc, A. Baltalarli, N. Postaci, R. Demir, and M. Sagban
Late Effect of Mechanical Mitral Valve Diameter on Left Ventricular Function
Asian Cardiovascular and Thoracic Annals, March 1, 1999; 7(1): 30 - 32.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. Esper, F. D. Ferdinand, S. Aronson, and R. B. Karp
Prosthetic Mitral Valve Replacement: Late Complications After Native Valve Preservation
Ann. Thorac. Surg., February 1, 1997; 63(2): 541 - 543.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
V. Rao, M. Komeda, R. D. Weisel, J. Ivanov, J. S. Ikonomidis, T. Shirai, and T. E. David
Results of Represervation of the Chordae Tendineae During Redo Mitral Valve Replacement
Ann. Thorac. Surg., July 1, 1996; 62(1): 179 - 183.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
A. F. Carpentier, A. Lessana, J. Y. M. Relland, E. Belli, S. Mihaileanu, A. J. Berrebi, E. Palsky, and D. F. Loulmet
The "Physio-Ring": an advanced concept in mitral valve annuloplasty
Ann. Thorac. Surg., November 1, 1995; 60(5): 1177 - 1186.
[Abstract] [PDF]

Home page
 CirculationHome page
A. DeAnda Jr, M. Komeda, S. D. Nikolic, G. T. Daughters II, N. B. Ingels, and D. C. Miller
Left Ventricular Function, Twist, and Recoil After Mitral Valve Replacement
Circulation, November 1, 1995; 92(9): 458 - 466.
[Abstract] [Full Text]

Home page
 CirculationHome page
M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, A. J. Tajik, K. R. Bailey, and R. L. Frye
Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation : A Multivariate Analysis
Circulation, February 15, 1995; 91(4): 1022 - 1028.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
T. J. Vander Salm, L. A. Pape, and J. F. Mauser
Mitral valve replacement with complete retention of native leaflets
Ann. Thorac. Surg., January 1, 1995; 59(1): 52 - 55.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. R. Moon, A. DeAnda Jr, G. T. Daughters II, N. B. Ingels Jr, and D. C. Miller
Experimental evaluation of different chordal preservation methods during mitral valve replacement
Ann. Thorac. Surg., October 1, 1994; 58(4): 931 - 944.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Y. Okita, S. Miki, Y. Ueda, T. Tahata, T. Sakai, and K. Matsuyama
Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis
J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 42 - 51.
[Abstract] [Full Text]

Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
M. Shigenobu and S. Sano
Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation
Asian Cardiovascular and Thoracic Annals, June 1, 1994; 2(2): 90 - 94.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. A. Rose and M. C. Oz
Preservation of anterior leaflet chordae tendineae during mitral valve replacement
Ann. Thorac. Surg., March 1, 1994; 57(3): 768 - 769.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. K. Reed and L. I. G. Iverson
Simplified correction of outflow obstruction after mitral valve replacement
Ann. Thorac. Surg., November 1, 1992; 54(5): 985 - 986.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. J. Heath, E. T. Warren, and B. Nickels
Mitral valve replacement: Techniques to eliminate myocardial rupture and prevent valvular disruption
Ann. Thorac. Surg., October 1, 1991; 52(4): 839 - 841.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. F. O. Tyers
Mitral valve replacement: What should be the standard technique?
Ann. Thorac. Surg., June 1, 1990; 49(6): 861 - 862.
[PDF]

Home page
 Ann. Thorac. Surg.Home page
D. H. Harpole Jr, J. S. Rankin, W. G. Wolfe, F. M. Clements, P. Van Trigt, W. G. Young, and R. H. Jones
Effects of standard mitral valve replacement on left ventricular function
Ann. Thorac. Surg., June 1, 1990; 49(6): 866 - 874.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. J. V. Salm
Mitral Annular Calcification: A New Technique for Valve Replacement
Ann. Thorac. Surg., September 1, 1989; 48(3): 437 - 439.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. A. Cooley
Technical problems in mitral valve repair and replacement
Ann. Thorac. Surg., September 1, 1989; 48(3_suppl_1): S91 - S92.
[PDF]

Home page
 Ann. Thorac. Surg.Home page
T. E. David, M. Komeda, C. Pollick, and R. J. Burns
Mitral valve annuloplasty: The effect of the type on left ventricular function
Ann. Thorac. Surg., April 1, 1989; 47(4): 524 - 528.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. E. David
Mitral Valve Replacement with Preservation of Chordae Tendinae: Rationale and Technical Considerations
Ann. Thorac. Surg., June 1, 1986; 41(6): 680 - 682.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1986 by The Society of Thoracic Surgeons.