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J Thorac Cardiovasc Surg 2002;124:1078-1079
© 2002 The American Association for Thoracic Surgery

Editorials

Does the intertrigonal distance dilate? Never say never

From the Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication June 25, 2002. Accepted for publication July 10, 2002. Address for reprints: Patrick M. McCarthy, MD, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave, F25, Cleveland, OH 44195 (E-mail: mccartp@ccf.org).

The first 20% of the full text of this article appears below.

See related article on page 1216.

In an era of dynamic 3-dimensional (3-D) reconstruction using advanced magnetic resonance, echocardiographic, or computed tomographic imaging, a fundamental assumption of mitral valve repair has been challenged by a study based on an old method, anatomic observation and measurement of pathologic specimens. Hueb and colleagues ¹ from São Paulo have updated basic observational techniques by using computer analysis of digital photographs. The authors compared mitral valve and ventricular size in fixed cadaver hearts from normal patients (trauma death) with hearts from patients with advanced heart failure resulting from ischemic or idiopathic (non-Chagas) dilated cardiomyopathy.

Some of their findings were not surprising and confirmed prior studies and surgical observations. The left ventricle dilated to a globular shape and the mitral anulus dilated. ^2-4 However, there was no proportionality of left ventricular to mitral valve dilatation. Therefore, left ventricular remodeling and dilatation itself (increased sphericity) can lead to mitral regurgitation, not necessarily through a proportional amount of mitral valve annular dilatation. ⁵ The majority of the mitral annular dilatation occurred in the muscular portion (primarily along the posterior leaflet) with a mean increase of 78 mm (ischemic) to 164 mm (idiopathic). This also was expected and accounts for the . . . [Full Text of this Article]

Related Article

Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: New insights from anatomic study

Alexandre Ciappina Hueb, Fabio Biscegli Jatene, Luiz Felipe Pinho Moreira, Pablo Maria Pomerantzeff, Elias Kallás, and Sérgio Almeida de Oliveira
J. Thorac. Cardiovasc. Surg. 2002 124: 1216-1224. [Abstract] [Full Text] [PDF]

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