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.

Issue Section:
Technical Papers
Keywords:
cardiology, biomechanics, force, muscle
Topics:
Muscle, Valves, Geometry, Equilibrium (Physics), Displacement
1.
Godley
,
R. W.
,
Wann
,
L. S.
,
Rogers
,
E. W.
,
Feigenbaum
,
H.
, and
Weyman
,
A. E.
,
1981
, “
Incomplete Mitral Leaflet Closure in Patients with Papillary Muscle Dysfunction
,”
Circulation
,
63
, pp.
565
–
571
.
2.
Boltwood
,
C. M.
,
Tei
,
C.
,
Wong
,
M.
, and
Shah
,
P. M.
,
1983
, “
Quantitative Echocardiography of the Mitral Complex in Dilated Cardiomyopathy: the Mechanism of Functional Mitral Regurgitation
,”
Circulation
,
68
, pp.
498
–
508
.
3.
Burch
,
G. E.
,
DePasquale
,
N. P.
, and
Phillips
,
J. H.
,
1968
, “
The Syndrome of Papillary Muscle Dysfunction
,”
Am. Heart J.
,
75
, pp.
399
–
415
.
4.
Kaul
,
S.
,
Spotnitz
,
W. D.
,
Glasheen
,
W. P.
, and
Touchstone
,
D. A.
,
1991
, “
Mechanism of Ischemic Mitral Regurgitation. An Experimental Evaluation
,”
Circulation
,
84
, pp.
2167
–
2180
.
5.
Kono
,
T.
,
Sabbah
,
H. N.
,
Rosman
,
H.
,
Alam
,
M.
,
Jafri
,
S.
,
Stein
,
P. D.
, and
Goldstein
,
S.
,
1992
, “
Mechanism of Functional Mitral Regurgitation during Acute Myocardial Ischemia
,”
J. Am. Coll. Cardiol.
,
19
, pp.
1101
–
1105
.
6.
Kono
,
T.
,
Sabbah
,
H. N.
,
Stein
,
P. D.
,
Brymer
,
J. F.
, and
Khaja
,
F.
,
1991
, “
Left Ventricular Shape as a Determinant of Functional Mitral Regurgitation in Patients with Severe Heart Failure Secondary to either Coronary Artery Disease or Idiopathic Dilated Cardiomyopathy
,”
Am. J. Cardiol.
,
68
, pp.
355
–
359
.
7.
Sabbah
,
H. N.
,
Kono
,
T.
,
Rosman
,
H.
,
Jafri
,
S.
,
Stein
,
P. D.
, and
Goldstein
,
S.
,
1992
, “
Left Ventricular Shape: a Factor in the Etiology of Functional Mitral Regurgitation in Heart Failure
,”
Am. Heart J.
,
123
, pp.
961
–
966
.
8.
Kono
,
T.
,
Sabbah
,
H. N.
,
Rosman
,
H.
,
Alam
,
M.
,
Jafri
,
S.
, and
Goldstein
,
S.
,
1992
, “
Left Ventricular Shape is the Primary Determinant of Functional Mitral Regurgitation in Heart Failure
,”
J. Am. Coll. Cardiol.
,
20
, pp.
1594
–
1598
.
9.
Cohen
,
G. I.
,
Davison
,
M. B.
,
Klein
,
A. L.
,
Salcedo
,
E. E.
, and
Stewart
,
W. J.
,
1992
, “
A Comparison of Flow Convergence with other Transthoracic Echocardiographic Indexes of Prosthetic Mitral Regurgitation
,”
J. Am. Soc. Echocardiogr
,
5
, pp.
620
–
627
.
10.
Otsuji
,
Y.
,
Handschumacher
,
M. D.
,
Schwammenthal
,
E.
,
Jiang
,
L.
,
Song
,
J. K.
,
Guerrero
,
J. L.
,
Vlahakes
,
G. J.
, and
Levine
,
R. A.
,
1997
, “
Insights from Three-dimensional Echocardiography into the Mechanism of Functional Mitral Regurgitation: Direct In Vivo Demonstration of Altered Leaflet Tethering Geometry
,”
Circulation
,
96
, pp.
1999
–
2008
.
11.
Tsakiris
,
A. G.
,
Gordon
,
D. A.
,
Padiyar
,
R.
, and
Frechette
,
D.
,
1978
, “
Relation of Mitral Valve Opening and Closure to Left Atrial and Ventricular Pressures in the Intact Dog
,”
Am. J. Physiol.
,
234
, pp.
H146–H151
H146–H151
.
12.
He
,
S.
,
Fontaine
,
A. A.
,
Schwammenthal
,
E.
,
Yoganathan
,
A. P.
, and
Levine
,
R. A.
,
1997
, “
Integrated Mechanism for Functional Mitral Regurgitation. Leaflet Restriction vs Coapting Force: In Vitro Studies
,”
Circulation
,
96
, pp.
1826
–
1834
.
13.
Nielsen
,
S. L.
,
Nygaard
,
H.
,
Fontaine
,
A. A.
,
Hasenkam
,
J. M.
,
He
,
S.
,
Andersen
,
N. T.
, and
Yoganathan
,
A. P.
,
1999
, “
Chordal Force Distribution Determines Systolic Mitral Leaflet Configuration and Severity of Functional Mitral Regurgitation
,”
J. Am. Coll. Cardiol.
,
33
, pp.
843
–
853
.
14.
Yacoub, M., 1976, “Anatomy af the Mitral Valve Chordae and Cusps,” The Mitral Valve. A Pluridisciplinary Approach. D. Kalmonson, ed., Edward Arnold, London, pp. 15–20.
15.
Littell, R. C., Milliken, G. A., Stroup, W. W., and Wolfinger, R. D., 1996, “SAS© System for Mixed Models,” SAS Institute Inc., Cary, NC, pp. 491.
16.
Kunzelman
,
K. S.
, and
Cochran
,
R. P.
,
1990
, “
Mechanical Properties of Basal and Marginal Mitral Valve Chordae Tendineae
,”
ASAIO Trans.
,
36
, pp.
M405–M408
M405–M408
.
17.
Kunzelman
,
K. S.
, and
Cochran
,
R. P.
,
1992
, “
Stress/Strain Characteristics of Porcine Mitral Valve Tissue: Parallel versus Perpendicular Collagen Orientation
,”
J. Card. Surg.
,
7
, pp.
71
–
78
.
18.
May-Newman
,
K.
, and
Yin
,
F. C. P.
,
1998
, “
A Constitutive Law for Mitral Valve Tissue
,”
J. Biomech.
,
120
, pp.
38
–
47
.
19.
Izumi
,
S.
,
Miyatake
,
K.
,
Beppu
,
S.
,
Park
,
Y. D.
,
Nagata
,
S.
,
Morioka
,
S.
,
Sakakibara
,
H.
,
Moriyama
,
K.
, and
Nimura
,
Y.
,
1992
, “
The Gap between Mitral Leaflets as a Cause of Mitral Regurgitation: Relationship to Mitral Valve Prolapse
,”
Intern Med.
,
31
, pp.
28
–
32
.
20.
Izumi
,
S.
,
Miyatake
,
K.
,
Beppu
,
S.
,
Park
,
Y. D.
,
Nagata
,
S.
,
Kinoshita
,
N.
,
Sakakibara
,
H.
, and
Nimura
,
Y.
,
1987
, “
Mechanism of Mitral Regurgitation in Patients with Myocardial Infarction: A Study using Real-time Two-dimensional Doppler Flow Imaging and Echocardiography
,”
Circulation
,
76
, pp.
777
–
785
.
21.
Arts
,
T.
,
Meerbaum
,
S.
,
Reneman
,
R.
, and
Corday
,
E.
,
1983
, “
Stresses in the Closed Mitral Valve: A Model Study
,”
J. Biomech.
,
16
, pp.
539
–
547
.
22.
Reimink
,
M. S.
,
Kunzelman
,
K. S.
,
Verrier
,
E. D.
, and
Cochran
,
R. P.
,
1995
, “
The Effect of Anterior Chordal Replacement on Mitral Valve Function. A Finite Element Study
,”
ASAIO J.
,
41
, pp.
M754–M762
M754–M762
.
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