New Technique for Repairing Ischemic Mitral Valve Regurgitation and Remodeling of the left ventricle
New Technique for Repairing Ischemic Mitral Valve Regurgitation and Remodeling of the left ventricle
Ischemic Mitral valve regurgitation is a challenging medical problem that is caused by and results from REMODELING of the Ischemic left ventricle.
Remodeling leads to:
1. Displacement of Papillary muscles
2. Annular dilatation that prevents normal coaptation
3. Tethering of Mitral leaflets
This restricts mitral leaflet closure preventing proper coaptation which causes mitral regurgitation.
The standard operative technique to relieve ischemic MR is a Ring annuloplasty that reduces mitral annular area by bringing the dilated posterior annulus anteriorly to reduce the AP diameter and the leaflets into apposition.
Remodeling is a progressive process and continues after MR was initially treated by a ring therefore causing continuous LV shape changes with recurrence of the MR in 30% of the patients within 6 months from ring annuloplasty. The initial annular compensation for ventricular dilatation by a ring is not durable.
Several other techniques for preventing repairing IMR are known, however continues remodeling remains a major problem.
A new line of devises is presented here for repairing Ischemic Mitral regurgitation:
The idea is to reshape the left ventricle and reposition the papillary muscle by an external device that is anchored to either an annuloplasty ring or to the fibrous skeleton of the heart. The result is repairing of the existing MR and prevention of recurrent MR inducing "Reverse remodeling"
The three deferent devices are intended for–
1) An "open technique" - For patients having primary open heart surgery for IMR
with or without CABG
2) A Minimal invasive “trans apical” technique – Either as a primary
procedure or use in patients when previous annuloplasty ring failed and continued remodeling caused recurrence of MR
3) A Trans catheter technique - Either as a primary procedure or use in
patients when previous annuloplasty ring failed and continued remodeling caused
recurrence of MR