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J Thorac Cardiovasc Surg 2008;136:590-596
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Mitral valve motion after performing an edge-to-edge repair in an isolated swine heart

Hiroki Hasegawa, MD*, Yoshimori Araki, MD, PhD, Akihiko Usui, MD, PhD, Jun Yokote, MD, Shunei Saito, MD, PhD, Hideki Oshima, MD, PhD, Yuichi Ueda, MD, PhD

Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Received for publication November 21, 2007; revisions received February 2, 2008; accepted for publication March 7, 2008.

* Address for reprints: Hiroki Hasegawa, MD, Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. (Email: hirokih{at}med.nagoya-u.ac.jp).

Objectives: Mitral valve motion after performing an edge-to-edge repair is a major concern, but it has not yet been observed directly. Mitral valve motion was assessed by using a high-speed digital video camera and microsonometric analysis in an isolated swine heart, and any changes in the mitral valve area or the development of mitral stenosis symptoms were evaluated.

Methods: A temporary edge-to-edge repair model was created. The mitral valve motion was assessed by using a high-speed digital video camera, and the motion of the mitral annulus was measured by means of sonomicrometric analysis with or without performing edge-to-edge repair (n = 5). The left ventricular volumetric measurements were also measured with a conductance catheter. One cardiac cycle was divided into 4 phases: the mitral valve open phase, the isovolumic contraction phase, the aortic valve open phase, and the isovolumic relaxation phase.

Results: The mitral valve was divided into 2 orifices by using the edge-to-edge technique, and the mitral valve area decreased by approximately 30%. The ratio of mitral valve open phase significantly decreased (31.9% ± 3.4% vs 41.4% ± 3.7%, P = .04). There were no significant differences in the diameter and the changes of anteroposterior dimensions of the mitral annulus. The stroke volume and the peak positive and negative dp/dt values showed no obvious change, but dv/dt values increased slightly without significance after removing the edge-to-edge suture (118 ± 25 vs 130 ± 17 mL/s, P = .14).

Conclusions: The mitral valve area decreased slightly; however, edge-to-edge repair did not create symptomatic mitral stenosis and showed no adverse affects on cardiac function.

Abbreviations and Acronyms EtoE = edge-to-edge; LAP = left atrial pressure; LV = left ventricular; MS = mitral stenosis; MVA = mitral valve area; MVOP = mitral valve open phase; NM = normal mode; SV = stroke volume






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