Chordal Cutting Does Not Adversely Affect Left Ventricle Contractile Function

• Emmanuel Messas

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Chaim Yosefy

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Miguel Chaput

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• J. Luis Guerrero

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Suzanne Sullivan

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Philippe Menasché

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Alain Carpentier

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Michel Desnos

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Albert A. Hagege

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Gus J. Vlahakes

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

• Robert A. Levine

  From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

抄録

Background— Severing a limited number of second-order chordae to the anterior leaflet can improve ischemic mitral regurgitation (MR). Some concerns have been raised regarding possible influence on regional and global left ventricle (LV) function. We evaluated changes in cardiac function in 5 normal sheep with cutting of pre-instrumented chords in the beating heart to maintain constant load. Methods and Results— Under cardiopulmonary bypass, wires were placed around the 2 central basal chordae and brought outside the heart, which was restarted. Hemodynamic and imaging data were collected before and after chordal cutting by radiofrequency ablation using those wires. Segmental contractility was assessed invasively using sonomicrometers and noninvasively using Doppler tissue velocity and strain rate (with strain rate viewed as less load-dependent than ejection fraction) at 6 sites: base, mid-ventricle, and apex along the anteroseptal and posterolateral walls. We found no changes from before to after chordal cutting in LV end-diastolic volume (47.2±3.3 after cutting versus 48.4±4.6 mL before cutting, P =0.66), end-systolic volume (21.5±1.2 versus 22.3±2.8 mL, P =0.68), ejection fraction (54.2±1.8 versus 54.2±2.7%, P =0.96), systolic ventricular elastance (7.28±1.68 versus 7.66±2.11 mm Hg/mL, P =0.64), preload-recruitable stroke work (46.6±7.7 versus 50.2±10.7 mm Hg, P =0.76), and LVdP/dt (1480±238 versus 1392±250 mm Hg/s, P =0.45). Doppler tissue velocities and longitudinal strain rates surrounding the papillary muscles were unchanged, as were sonomicrometer longitudinal and mediolateral absolute strains. No wall motion abnormalities were visible around the papillary muscles, and no MR developed. Conclusion— We find no evidence for acutely decreased global or segmental LV contractility with chordal cutting. This absence of adverse effects is consistent with long-term clinical experience with cutting these chords in valve repair.

収録刊行物

• Circulation

  Circulation 114 (1_supplement), 2006-07-04

  Ovid Technologies (Wolters Kluwer Health)

キーワード

• Physiology (medical)
• Cardiology and Cardiovascular Medicine

詳細情報

• CRID: 1360855569545601920
• NII論文ID: 30022669417
• DOI: 10.1161/circulationaha.105.000612
• ISSN: 15244539
• ISSN: 00097322
• Web Site: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.105.000612
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