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Published in: Journal of Cardiothoracic Surgery 1/2023

Open Access 01-12-2023 | Research

Anatomical and biometric study of the mitral valve apparatus: application in valve repair surgery

Authors: Misbaou Barry, Mesut Gun, Yuthiline Hun-Chabry, Majid Harmouche, Johann Peltier, Thierry Caus, Eric Havet

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

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Abstract

Objective

Most mitral valve repair techniques provide excellent surgical results by removing regurgitation, but all of these techniques simultaneously reduce posterior valve mobility. A comprehensive biometric study of the mitral valve apparatus will provide landmarks that would help improve this posterior valve mobility.

Materials and methods

Thirty one (31) human hearts have been studied, from 14 women and 17 men. The characteristics of the studied sample were analyzed descriptively. The difference in means of the variables between women and men were tested using a Student t test. Correlations between the different measures were determined by simple regression analysis. Mean values are shown with ± 1 standard deviation and the limit of significance was set at 0.05.

Results

The mean weight of the hearts was 275.3 ± 2.4 g. The anteroposterior diameter of the mitral annulus was 29.3 ± 1.22 mm, the intertrigonal distance was 25.2 ± 3.50 mm and the anterior leaflet to posterior leaflet ratio was 1.9 ± 0.10, the length of the chordae A2 = 19.4 ± 1.15 mm and P2 = 14.5 ± 0.85 mm. The length of the anterior papillary muscle averaged 30.9 ± 7.20 mm and that of the posterior one 30.0 ± 8.75 mm. The comparison of the different values measured between women and men showed no statistically significant difference (p > 0.05). There was no correlation between these different measured values (p > 0.05).

Conclusion

A perfect knowledge of anatomy and biometry is therefore essential to offer alternative techniques that reproduce the real anatomy and physiology with a complete reconstruction of the mitral valve.
Literature
1.
go back to reference Van Mieghem NM, Piazza N, Anderson RH, et al. Anatomy of the mitral valvular complex and its implications for transcatheter interventions for mitral regurgitation [archive]. J Am Coll Cardiol. 2010;6:617–26.CrossRef Van Mieghem NM, Piazza N, Anderson RH, et al. Anatomy of the mitral valvular complex and its implications for transcatheter interventions for mitral regurgitation [archive]. J Am Coll Cardiol. 2010;6:617–26.CrossRef
2.
go back to reference Vetter T. Un siècle d'histoire de la circulation du sang 1564–1664, Documenta Geigy, chap. fascicule 3 (« Harvey et la grande circulation »);1965. pp. 30–32. Vetter T. Un siècle d'histoire de la circulation du sang 1564–1664, Documenta Geigy, chap. fascicule 3 (« Harvey et la grande circulation »);1965. pp. 30–32.
3.
go back to reference Lillehei CW, Vl G, Dewall RA, Varco RL. Surgical correction of pure mitral insufficiency by annuloplasty under direct vision. J Lancet. 1957;77:446–9.PubMed Lillehei CW, Vl G, Dewall RA, Varco RL. Surgical correction of pure mitral insufficiency by annuloplasty under direct vision. J Lancet. 1957;77:446–9.PubMed
4.
go back to reference Carpentier A. La valvuloplastie reconstructive ; une nouvelle technique de la valvuloplastie mitrale. In: La presse médicale;1969. 251–253. Carpentier A. La valvuloplastie reconstructive ; une nouvelle technique de la valvuloplastie mitrale. In: La presse médicale;1969. 251–253.
5.
go back to reference Meruane J, Duran G, Saavedra J, Perales L, Reyes J, Escobar E. Mitral valve replacement: 6 years experience in 119 cases (author’s transl). Rev Med Chil. 1974;102:607–12.PubMed Meruane J, Duran G, Saavedra J, Perales L, Reyes J, Escobar E. Mitral valve replacement: 6 years experience in 119 cases (author’s transl). Rev Med Chil. 1974;102:607–12.PubMed
6.
go back to reference Ragnarsson S, Sjogren J, Sánchez R, Wierup P, Nozohour S. Polytetrafluoroethylene neochordae is noninferior to leaflet resection in repair of isolated posterior mitral leaflet prolapse: a multicentre study. Interact Cardiovasc Thorac Surg. 2015;20(4):463–8. Ragnarsson S, Sjogren J, Sánchez R, Wierup P, Nozohour S. Polytetrafluoroethylene neochordae is noninferior to leaflet resection in repair of isolated posterior mitral leaflet prolapse: a multicentre study. Interact Cardiovasc Thorac Surg. 2015;20(4):463–8.
7.
go back to reference Yacoub M, Halim M, Radley-Smith R, Mckay R, Nijveld A, Towers M. Surgicaltreatment of mitral regurgitation caused by floppy valves; repair versus replacement. Circulation. 1981;64:210–6. Yacoub M, Halim M, Radley-Smith R, Mckay R, Nijveld A, Towers M. Surgicaltreatment of mitral regurgitation caused by floppy valves; repair versus replacement. Circulation. 1981;64:210–6.
8.
go back to reference Lytle BW, Cosgrove DM, Borsh J, Castle LA, Loop FD. Mitral valve replacement. Results 20 years after operation. Cleve clin Q. 1985;52:369–73.CrossRefPubMed Lytle BW, Cosgrove DM, Borsh J, Castle LA, Loop FD. Mitral valve replacement. Results 20 years after operation. Cleve clin Q. 1985;52:369–73.CrossRefPubMed
9.
go back to reference David TEBJ, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg. 1991;101:495–551.CrossRefPubMed David TEBJ, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg. 1991;101:495–551.CrossRefPubMed
10.
go back to reference David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. Chirurgie Cardio-vasc J Thorac. 1991;101(3):495–501.CrossRef David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. Chirurgie Cardio-vasc J Thorac. 1991;101(3):495–501.CrossRef
11.
go back to reference Schubert SA, Mehaffey JH, Charles EJ, Kron IL. Mitral valve repair: the French correction versus the American correction. Surg Clin North Am. 2017;97(4):867–88.CrossRefPubMedPubMedCentral Schubert SA, Mehaffey JH, Charles EJ, Kron IL. Mitral valve repair: the French correction versus the American correction. Surg Clin North Am. 2017;97(4):867–88.CrossRefPubMedPubMedCentral
12.
go back to reference Lam J, Ranganathan N, Wigle D, Silver D. Morphology of the human mitral valve chordae tendineae: a new classification. Circulation 1970; XLI. Lam J, Ranganathan N, Wigle D, Silver D. Morphology of the human mitral valve chordae tendineae: a new classification. Circulation 1970; XLI.
13.
go back to reference Ozbag D, Gumusalan Y, Demirant A. The comparative investigation of morphology of papillary muscles of left ventricle in different species. J Am Coll Cardiol. 2014;63(9):914–9. Ozbag D, Gumusalan Y, Demirant A. The comparative investigation of morphology of papillary muscles of left ventricle in different species. J Am Coll Cardiol. 2014;63(9):914–9.
15.
go back to reference Gun M, Barry M, Bohbot Y, Tribouilloy C, Touati G. Modeling of the length of the mitral cords in echocardiography according to their manual measurement in the operating room. J Chirurgie cardiothoracique. 2022;17:64. Gun M, Barry M, Bohbot Y, Tribouilloy C, Touati G. Modeling of the length of the mitral cords in echocardiography according to their manual measurement in the operating room. J Chirurgie cardiothoracique. 2022;17:64.
16.
go back to reference Seeburger J, Rinaldi M, Nielsen S, Salizzoni S, Lange R, Schoenburg M, Alfieri O, Borger M, Mohr FW, Aidietis A. Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept. J Am Coll Cardiol. 2014;63(9):914–9.CrossRefPubMed Seeburger J, Rinaldi M, Nielsen S, Salizzoni S, Lange R, Schoenburg M, Alfieri O, Borger M, Mohr FW, Aidietis A. Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept. J Am Coll Cardiol. 2014;63(9):914–9.CrossRefPubMed
17.
go back to reference Hata H, Fujita T, Shimahara Y, Sato S, Ishibashi-Ueda H, Kobayashi J. A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. J Cardiovasc Surg. 2017;58(5):779–86. Hata H, Fujita T, Shimahara Y, Sato S, Ishibashi-Ueda H, Kobayashi J. A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. J Cardiovasc Surg. 2017;58(5):779–86.
18.
go back to reference Abicht TO, Andrei A-C, Kruse J, McDonald E, Li Z, McCarthy PM. A simple approach to mitral valve repair: posterior leaflet height adjustment using a partial fold of the free edge. J Thorac Cardiovasc Surg. 2014;148(6):2780–6.CrossRefPubMed Abicht TO, Andrei A-C, Kruse J, McDonald E, Li Z, McCarthy PM. A simple approach to mitral valve repair: posterior leaflet height adjustment using a partial fold of the free edge. J Thorac Cardiovasc Surg. 2014;148(6):2780–6.CrossRefPubMed
19.
go back to reference Carvalho JL, Schaff HV, Nishimura RA, Ommen SR, Geske JB, Lahr BD, Newman DB, Dearan JA. Is anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy? J Thorac Cardiovasc Surg. 2021;S0022–5223. Carvalho JL, Schaff HV, Nishimura RA, Ommen SR, Geske JB, Lahr BD, Newman DB, Dearan JA. Is anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy? J Thorac Cardiovasc Surg. 2021;S0022–5223.
Metadata
Title
Anatomical and biometric study of the mitral valve apparatus: application in valve repair surgery
Authors
Misbaou Barry
Mesut Gun
Yuthiline Hun-Chabry
Majid Harmouche
Johann Peltier
Thierry Caus
Eric Havet
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2023
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-023-02232-2

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