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三尖瓣环在体外猪心的心索断裂后立即扩张。

Dilation of tricuspid valve annulus immediately after rupture of chordae tendineae in ex-vivo porcine hearts.

机构信息

Department of Biomedical Engineering, The University of Akron, Akron, OH, United States of America.

Mid Atlantic Surgical Associates, Neptune, NJ, United States of America.

出版信息

PLoS One. 2018 Nov 8;13(11):e0206744. doi: 10.1371/journal.pone.0206744. eCollection 2018.

DOI:10.1371/journal.pone.0206744
PMID:30408050
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6226105/
Abstract

PURPOSE

Chordae rupture is one of the main lesions observed in traumatic heart events that might lead to severe tricuspid valve (TV) regurgitation. TV regurgitation following chordae rupture is often well tolerated with few or no symptoms for most patients. However, early repair of the TV is of great importance, as it might prevent further exacerbation of the regurgitation due to remodeling responses. To understand how TV regurgitation develops following this acute event, we investigated the changes on TV geometry, mechanics, and function of ex-vivo porcine hearts following chordae rupture.

METHODS

Sonomicrometry techniques were employed in an ex-vivo heart apparatus to identify how the annulus geometry alters throughout the cardiac cycle after chordae rupture, leading to the development of TV regurgitation.

RESULTS

We observed that the TV annulus significantly dilated (~9% in area) immediately after chordae rupture. The annulus area and circumference ranged from 11.4 ± 2.8 to 13.3 ± 2.9 cm2 and from 12.5 ± 1.5 to 13.5 ± 1.3 cm, respectively, during the cardiac cycle for the intact heart. After chordae rupture, the annulus area and circumference were larger and ranged from 12.3 ± 3.0 to 14.4 ± 2.9 cm2 and from 13.0 ± 1.5 to 14.0 ± 1.2 cm, respectively.

CONCLUSIONS

In our ex-vivo study, we showed for the first time that the TV annulus dilates immediately after chordae rupture. Consequently, secondary TV regurgitation may be developed because of such changes in the annulus geometry. In addition, the TV leaflet and the right ventricle myocardium are subjected to a different mechanical environment, potentially causing further negative remodeling responses and exacerbating the detrimental outcomes of chordae rupture.

摘要

目的

腱索断裂是外伤性心脏事件中观察到的主要病变之一，可能导致严重的三尖瓣（TV）反流。对于大多数患者来说，腱索断裂后 TV 反流通常能够很好地耐受，仅有少数或没有症状。然而，TV 的早期修复非常重要，因为它可能防止由于重塑反应导致反流进一步恶化。为了了解 TV 反流在这种急性事件后是如何发展的，我们研究了在腱索断裂后，猪离体心脏 TV 几何形状、力学和功能的变化。

方法

在离体心脏装置中使用超声心动描记术技术来确定腱索断裂后，TV 环在整个心动周期中如何改变，导致 TV 反流的发展。

结果

我们观察到 TV 瓣环在腱索断裂后立即显著扩张（面积约 9%）。在完整心脏的心动周期中，瓣环面积和周长分别为 11.4 ± 2.8 至 13.3 ± 2.9 cm2 和 12.5 ± 1.5 至 13.5 ± 1.3 cm。腱索断裂后，瓣环面积和周长分别增大至 12.3 ± 3.0 至 14.4 ± 2.9 cm2 和 13.0 ± 1.5 至 14.0 ± 1.2 cm。

结论

在我们的离体研究中，我们首次表明 TV 瓣环在腱索断裂后立即扩张。因此，可能会由于瓣环几何形状的这种变化而继发 TV 反流。此外，TV 瓣叶和右心室心肌受到不同的力学环境的影响，可能导致进一步的负性重塑反应，并使腱索断裂的不良后果恶化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/25b3b3c90fe4/pone.0206744.g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/9143611e48d7/pone.0206744.g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/a178dd714958/pone.0206744.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/4d242a055dcf/pone.0206744.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/4c98d3105693/pone.0206744.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/5133f97f5388/pone.0206744.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/d44e31ffe486/pone.0206744.g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/25b3b3c90fe4/pone.0206744.g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/9143611e48d7/pone.0206744.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/ae17d700f967/pone.0206744.g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/45dc/6226105/25b3b3c90fe4/pone.0206744.g008.jpg

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