In Vitro System for Measuring Chordal Force Changes Following Mitral Valve Patch Repair.
BACKGROUND
Attention towards optimization of mitral valve repair methods is increasing. Patch augmentation is one strategy utilized to correct functional mitral regurgitation or systolic anterior motion in complex mitral valve repairs. This article describes a system for investigating the redistribution of chordae tendineae tension as a reflection of altered stress distribution of the valve leaflet following patch augmentation.


METHODS
An in vitro test setup was constructed to hold native porcine mitral valves containing an annulus and papillary muscle positioning system. The alterations caused by patch augmentation should be visual from both the atrial and ventricular views. Ventricular pressure was regulated stepwise in a range of 0-150 mmHg. To test the system, the anterior mitral leaflet was extended by a pericardial patch sutured to the mid/basal part of the leaflet, and the chordae tendineae force was measured as the ventricular pressure was applied.


RESULTS
The system demonstrated the capacity to hold native porcine mitral valves and introducing patch repairs according to clinical practice. The porcine mitral valve test setup indicated strong correlation between the forces in the mitral valve secondary chordae tendineae and the applied transvalvular pressure (R2= 0.95).


CONCLUSIONS
This test setup proved the ability to obtain normal mid-systolic mitral valve function, secondary chordae force measurements, and important preservation of the visual access: Hence, obtaining the pressure-force relationship as well as identifying any shift of the secondary chordae insertion point on the anterior leaflet relative to the coaptation zone was made possible.
Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark.
B
B
Ostli
Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark.
J
J
Vester-Petersen
Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
J B
JB
Askov
Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
J L
JL
Honge
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
R A
RA
Levine
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology; University Paris Descartes; INSERM U 633; Paris, France.
A
A
Hagège
Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
S L
SL
Nielsen
Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
J M
JM
Hasenkam
Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
H
H
Nygaard
Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
M O
MO
Jensen
In vitro; Mitral valve; biomechanics; force; left ventricle