Objectives: We have developed a stentless pericardial mitral valve prosthesis in 2 configurations; the purposes of this acute study in sheep were to assess (1) valve design and implant technique; (2) valve performance; and (3) acute effects on postimplant left ventricular function.
Methods: A stentless bovine pericardial bileaflet valve was developed with the intent to preserve annular-papillary muscle continuity. This valve, in 2 configurations-with (n = 5) and without (n = 5) flap chordae-was implanted in 10 sheep (mean weight 73 +/- 9 kg). Epicardial echocardiography was performed to assess valve performance. Load-independent left ventricular function was also estimated before implantation (baseline), 1 hour after discontinuing cardiopulmonary bypass (rest), and during dobutamine stimulation using conductance technology.
Results: Implantation was easily accomplished for both configurations. Both configurations had low transvalvular pressure (mean 2.1 +/- 1.2 mm Hg at rest; 2.2 +/- 1.0 mm Hg with dobutamine stimulation with flap chordae; 1.7 +/- 0.5 mm Hg and 1.6 +/- 0.3 mm Hg without flap chordae). No mitral regurgitation was observed in 8 sheep, and mild regurgitation was seen in 2 sheep. Compared with baseline, slope of maximum rate of change of left ventricular pressure-end-diastolic volume relation increased with stimulation both with flap chordae (+52 +/- 41 mm Hg x s(-1)x mL(-1), P = .0005) and without (+20 +/- 12 mm Hg x s(-1) x mL(-1), P = .003).
Conclusions: Both configurations of this newly designed stentless mitral bioprosthesis, which preserves annular-papillary muscle continuity using different novel surgical implantation techniques, demonstrated reliable valve performance, with low transvalvular pressure gradients, minimal regurgitation, and acutely preserved postimplant left ventricular function. Further chronic study is needed to verify these results and evaluate reliability of implantation procedures, biocompatibility, and durability.
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http://dx.doi.org/10.1016/j.jtcvs.2006.11.044 | DOI Listing |
Cureus
December 2024
Internal Medicine, Kempegowda Institute of Medical Sciences, Bangalore, IND.
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View Article and Find Full Text PDFFront Endocrinol (Lausanne)
December 2024
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Diabetic cardiomyopathy (DMCM), defined as left ventricular dysfunction in the setting of diabetes mellitus without hypertension, coronary artery disease or valvular heart disease, is a well-recognized entity whose prevalence is certainly predicted to increase alongside the rising incidence and prevalence of diabetes mellitus. The pathophysiology of DMCM stems from hyperglycemia and insulin resistance, resulting in oxidative stress, inflammation, cardiomyocyte death, and fibrosis. These perturbations lead to left ventricular hypertrophy with associated impaired relaxation early in the course of the disease, and eventually culminating in combined systolic and diastolic heart failure.
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