Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective
Background: The exact geometric pathogenesis of leaflet tethering in ischemic mitral regurgitation (IMR) and the relative contribution of each component of the mitral valve complex (MVC) remain largely unknown. In this study, we sought to further elucidate mitral valve (MV) leaflet remodeling and pa...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273620301315 |
| _version_ | 1811328311804035072 |
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| author | Ahmed H. Aly, PhD Yoshiaki Saito, MD, PhD Wobbe Bouma, MD, PhD James J. Pilla, PhD Alison M. Pouch, PhD Paul A. Yushkevich, PhD Matthew J. Gillespie, MD Joseph H. Gorman, III, MD Robert C. Gorman, MD |
| author_facet | Ahmed H. Aly, PhD Yoshiaki Saito, MD, PhD Wobbe Bouma, MD, PhD James J. Pilla, PhD Alison M. Pouch, PhD Paul A. Yushkevich, PhD Matthew J. Gillespie, MD Joseph H. Gorman, III, MD Robert C. Gorman, MD |
| author_sort | Ahmed H. Aly, PhD |
| collection | DOAJ |
| description | Background: The exact geometric pathogenesis of leaflet tethering in ischemic mitral regurgitation (IMR) and the relative contribution of each component of the mitral valve complex (MVC) remain largely unknown. In this study, we sought to further elucidate mitral valve (MV) leaflet remodeling and papillary muscle dynamics in an ovine model of IMR with magnetic resonance imaging (MRI) and 3-dimensional echocardiography (3DE). Methods: Multimodal imaging combining 3DE and MRI was used to analyze the MVC at baseline, 30 minutes post–myocardial infarction (MI), and 12 weeks post-MI in ovine IMR models. Advanced 3D imaging software was used to trace the MVC from each modality, and the tracings were verified against resected specimens. Results: 3DE MV remodeling was regionally heterogenous and observed primarily in the anterior leaflet, with significant increases in surface area, especially in A2 and A3. The posterior leaflet was significantly shortened in P2 and P3. Mean posteromedial papillary muscle (PMPM) volume was decreased from 1.9 ± 0.2 cm3 at baseline to 0.9 ± 0.3 cm3 at 12 weeks post-MI (P < .05). At 12 weeks post-MI, the PMPM was predominately displaced horizontally and outward along the intercommissural axis with minor apical displacement. The subvalvular contribution to tethering is a combination of unilateral movement, outward displacement, and degeneration of the PMPM. These findings have led to a proposed new framework for characterizing PMPM dynamics in IMR. Conclusions: This study provides new insights into the complex interrelated and regionally heterogenous valvular and subvalvular mechanisms involved in the geometric pathogenesis of IMR tethering. |
| first_indexed | 2024-04-13T15:24:11Z |
| format | Article |
| id | doaj.art-253c8bb6ef214e22ac842240100097d1 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-13T15:24:11Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-253c8bb6ef214e22ac842240100097d12022-12-22T02:41:34ZengElsevierJTCVS Open2666-27362021-03-0154860Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspectiveAhmed H. Aly, PhD0Yoshiaki Saito, MD, PhD1Wobbe Bouma, MD, PhD2James J. Pilla, PhD3Alison M. Pouch, PhD4Paul A. Yushkevich, PhD5Matthew J. Gillespie, MD6Joseph H. Gorman, III, MD7Robert C. Gorman, MD8Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Bioengineering, University of Pennsylvania, Philadelphia, PaGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Thoracic and Cardiovascular Surgery, Hirosaki University, Aomori, JapanDepartment of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PaGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PaDepartment of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PaGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PaGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PaGorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Address for reprints: Robert C. Gorman, MD, Gorman Cardiovascular Research Group, Smilow Center for Translational Research, 3400 Civic Center Blvd, Bldg 421, 11th Floor, Room 114, Philadelphia, PA, 19104-5156.Background: The exact geometric pathogenesis of leaflet tethering in ischemic mitral regurgitation (IMR) and the relative contribution of each component of the mitral valve complex (MVC) remain largely unknown. In this study, we sought to further elucidate mitral valve (MV) leaflet remodeling and papillary muscle dynamics in an ovine model of IMR with magnetic resonance imaging (MRI) and 3-dimensional echocardiography (3DE). Methods: Multimodal imaging combining 3DE and MRI was used to analyze the MVC at baseline, 30 minutes post–myocardial infarction (MI), and 12 weeks post-MI in ovine IMR models. Advanced 3D imaging software was used to trace the MVC from each modality, and the tracings were verified against resected specimens. Results: 3DE MV remodeling was regionally heterogenous and observed primarily in the anterior leaflet, with significant increases in surface area, especially in A2 and A3. The posterior leaflet was significantly shortened in P2 and P3. Mean posteromedial papillary muscle (PMPM) volume was decreased from 1.9 ± 0.2 cm3 at baseline to 0.9 ± 0.3 cm3 at 12 weeks post-MI (P < .05). At 12 weeks post-MI, the PMPM was predominately displaced horizontally and outward along the intercommissural axis with minor apical displacement. The subvalvular contribution to tethering is a combination of unilateral movement, outward displacement, and degeneration of the PMPM. These findings have led to a proposed new framework for characterizing PMPM dynamics in IMR. Conclusions: This study provides new insights into the complex interrelated and regionally heterogenous valvular and subvalvular mechanisms involved in the geometric pathogenesis of IMR tethering.http://www.sciencedirect.com/science/article/pii/S2666273620301315ischemic mitral regurgitationimage analysis3D echocardiographymagnetic resonance imagingmultimodal imaging |
| spellingShingle | Ahmed H. Aly, PhD Yoshiaki Saito, MD, PhD Wobbe Bouma, MD, PhD James J. Pilla, PhD Alison M. Pouch, PhD Paul A. Yushkevich, PhD Matthew J. Gillespie, MD Joseph H. Gorman, III, MD Robert C. Gorman, MD Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective JTCVS Open ischemic mitral regurgitation image analysis 3D echocardiography magnetic resonance imaging multimodal imaging |
| title | Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective |
| title_full | Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective |
| title_fullStr | Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective |
| title_full_unstemmed | Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective |
| title_short | Multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationCentral MessagePerspective |
| title_sort | multimodal image analysis and subvalvular dynamics in ischemic mitral regurgitationcentral messageperspective |
| topic | ischemic mitral regurgitation image analysis 3D echocardiography magnetic resonance imaging multimodal imaging |
| url | http://www.sciencedirect.com/science/article/pii/S2666273620301315 |
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