Mechanism of incomplete mitral leaflet coaptation--interaction of chordal restraint and changes in mitral leaflet coaptation geometry. Insight from in vitro validation of the premise of force equilibrium.
Clinically observed incomplete mitral leaflet coaptation was reproduced in vitro by altering the balance of the chordal tethering and chordal coapting force components. Mitral leaflet coaptation geometry was distorted by changes of the spatial relations between the papillary muscles and the mitral valve as well as hemodynamics. Mitral leaflet malalignment was accentuated by a redistribution of the chordal tethering and coapting force components. For the overall assessment of systolic mitral leaflet configuration in functional mitral regurgitation it is important to consider the interaction between chordal restraint and an altered mitral leaflet coaptation geometry.
Nielsen
Sten Lyager
SL
Department of Cardiothoracic and Vascular Surgery, Institute of Experimental Clinical Research, Skejby Sygehus, Aarhus University Hospital, Denmark.
Nygaard
Hans
H
Mandrup
Lars
L
Fontaine
Arnold A
AA
Hasenkam
J Michael
JM
He
Shengqui
S
Yoganathan
Ajit P
AP
D000222:Adaptation, Physiological; D000818:Animals; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D066298:In Vitro Techniques; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008955:Models, Cardiovascular; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004856:Postural Balance; D011312:Pressure; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013552:Swine; D013599:Systole / Q000502:physiology; D020257:Ventricular Remodeling