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心肌梗死后二尖瓣瓣叶重构的体内评估。

In vivo assessment of mitral valve leaflet remodelling following myocardial infarction.

机构信息

James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and the Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.

Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Sci Rep. 2022 Oct 26;12(1):18012. doi: 10.1038/s41598-022-22790-0.

Abstract

Each year, more than 40,000 people undergo mitral valve (MV) repair surgery domestically to treat regurgitation caused by myocardial infarction (MI). Although continual MV tissue remodelling following repair is believed to be a major contributor to regurgitation recurrence, the effects of the post-MI state on MV remodelling remain poorly understood. This lack of understanding limits our ability to predict the remodelling of the MV both post-MI and post-surgery to facilitate surgical planning. As a necessary first step, the present study was undertaken to noninvasively quantify the effects of MI on MV remodelling in terms of leaflet geometry and deformation. MI was induced in eight adult Dorset sheep, and real-time three-dimensional echocardiographic (rt-3DE) scans were collected pre-MI as well as at 0, 4, and 8 weeks post-MI. A previously validated image-based morphing pipeline was used to register corresponding open- and closed-state scans and extract local in-plane strains throughout the leaflet surface at systole. We determined that MI induced permanent changes in leaflet dimensions in the diastolic configuration, which increased with time to 4 weeks, then stabilised. MI substantially affected the systolic shape of the MV, and the range of stretch experienced by the MV leaflet at peak systole was substantially reduced when referred to the current time-point. Interestingly, when we referred the leaflet strains to the pre-MI configuration, the systolic strains remained very similar throughout the post-MI period. Overall, we observed that post-MI ventricular remodeling induced permanent changes in the MV leaflet shape. This predominantly affected the MV's diastolic configuration, leading in turn to a significant decrease in the range of stretch experienced by the leaflet when referenced to the current diastolic configuration. These findings are consistent with our previous work that demonstrated increased plastic (i.e. non-recoverable) leaflet deformations post-MI, that was completely accounted for by the associated changes in collagen fiber structure. Moreover, we demonstrated through noninvasive methods that the state of the MV leaflet can elucidate the progression and extent of MV adaptation following MI and is thus highly relevant to the design of current and novel patient specific minimally invasive surgical repair strategies.

摘要

每年,国内有超过 4 万人接受二尖瓣(MV)修复手术,以治疗心肌梗死(MI)引起的反流。尽管人们认为修复后持续的 MV 组织重塑是反流复发的主要原因,但 MI 对 MV 重塑的影响仍知之甚少。这种缺乏了解限制了我们预测 MV 在 MI 后和手术后重塑的能力,从而难以进行手术规划。作为必要的第一步,本研究旨在非侵入性地量化 MI 对 MV 重塑的影响,包括瓣叶几何形状和变形。在 8 只成年多塞特绵羊中诱导 MI,并在 MI 前以及 MI 后 0、4 和 8 周采集实时三维超声心动图(rt-3DE)扫描。使用经过验证的基于图像的变形管道来注册相应的开放和闭合状态扫描,并在收缩期提取整个瓣叶表面的局部平面应变。我们发现 MI 在舒张期构型中永久性地改变了瓣叶尺寸,这种变化随时间增加到 4 周,然后稳定下来。MI 极大地影响了 MV 的收缩期形态,并且当参考当前时间点时,MV 瓣叶在收缩期峰值经历的伸展范围大大减小。有趣的是,当我们将瓣叶应变参考到 MI 前的构型时,整个 MI 后期间的收缩期应变仍然非常相似。总的来说,我们观察到 MI 后心室重构导致 MV 瓣叶形状发生永久性变化。这主要影响 MV 的舒张构型,反过来导致瓣叶在参考当前舒张构型时经历的伸展范围显著减小。这些发现与我们之前的工作一致,该工作表明 MI 后瓣叶发生了增加的塑性(即不可恢复)变形,而这完全由胶原纤维结构的相关变化引起。此外,我们通过非侵入性方法证明,MV 瓣叶的状态可以阐明 MI 后 MV 适应的进展和程度,因此与当前和新型患者特异性微创修复策略的设计高度相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebe5/9606267/e6a6d5bc659e/41598_2022_22790_Fig1_HTML.jpg

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