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J Thorac Cardiovasc Surg 2006;132:1414-1419
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effects of hemodynamic alterations on anterior mitral leaflet curvature during systole

Hiroaki Sakamoto, MD*, Landi M. Parish, SB*, Hirotsugu Hamamoto, MD, Yoshiharu Enomoto, MD, Ahmad Zeeshan, MD, Theodore Plappert, CVT, Benjamin M. Jackson, MD, Martin G. St. John-Sutton, MD, Robert C. Gorman, MD, Joseph H. Gorman, III, MD*

Harrison Department of Surgical Research, Department Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pa.

Received for publication April 12, 2006; accepted for publication August 25, 2006.

* Address for reprints: Joseph H. Gorman, III, MD, University of Pennsylvania, 313 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, PA 19104. (Email: gormanj{at}uphs.upenn.edu).

OBJECTIVES: The application of repair techniques to treat mitral valve incompetence has increased progressively during the past 20 years. Unfortunately, recent reports have demonstrated the longevity of these repairs to be less than previously believed. Most repair failures are stress related. Computational models to optimize valve repair are in development, but to be brought to fruition, a better understanding of dynamic leaflet geometry is necessary. In this study, sonomicrometry was used in an ovine model to compute systolic leaflet curvature at varying afterloads and states of contractility.

METHODS: The anterior leaflet of 12 sheep was instrumented with 5 piezoelectric transducers in a cruciate array. Systolic blood pressure ranged from 90 to 200 mm Hg with increasing phenylephrine hydrochloride infusion. Epinephrine was used to vary contractile state. Leaflet curvature was calculated continuously (200 Hz) during systole.

RESULTS: Anterior leaflet curvature in the septolateral direction was double that in the intercommisural direction. There were also significant changes in leaflet curvature during systole. Curvature in neither direction was affected by afterload. Epinephrine augmented intercommisural curvature in a dose-independent fashion, whereas it had no effect on curvature in the septolateral direction.

CONCLUSIONS: Dynamic mitral anterior leaflet geometry was found to be amazingly constant over a wide range of hemodynamic conditions. These data provide information about leaflet geometry that will aid in the construction of realistic computational models. Such models may facilitate the design of annuloplasty rings and surgical techniques that minimize leaflet stress and increase mitral valve repair longevity.

Abbreviations and Acronyms ARP = aortic root pressure; ED = end diastole; ES = end systole; MS = mid-systole




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