Circulation, Vol 84, 2167-2180, Copyright © 1991 by American Heart Association
S Kaul, WD Spotnitz, WP Glasheen and DA Touchstone
BACKGROUND. Papillary muscle dysfunction (PMD) has been implicated in the
pathogenesis of ischemic mitral regurgitation (MR). We hypothesized that
ischemic MR is not caused by PMD and/or dysfunction of the myocardial
regions from where the papillary muscles arise but is related to reduction
in global left ventricular (LV) function. To test this hypothesis, three
groups of dogs were studied. METHODS AND RESULTS. In group 1 dogs (n = 8),
varying degrees of regional and global LV dysfunction were produced. In
group 2 dogs (n = 7), the circulation to the papillary muscles was isolated
from that of the rest of the LV. Dysfunction of one or both papillary
muscles was produced without producing global LV dysfunction. Global LV
dysfunction was also produced while keeping papillary muscle function
intact. The degree of MR (assessed using contrast echocardiography) was
correlated in both groups of dogs with thickening of the papillary muscles
and regional and global LV function. In the group 3 dogs (n = 6), the
spatial distribution of blood flow within each papillary muscle was
determined during ischemia by using radiolabeled microspheres. Thickening
of the papillary muscles was assessed at three different levels along their
lengths and was correlated with average blood flow at these levels. In
group 1 dogs, MR was noted only when global LV function was affected and
its severity correlated inversely with global LV function (r = - 0.84 with
peak positive LV dP/dt and r = -0.95 with global LV thickening,
respectively). In comparison, there was poor correlation between MR and
anterior and posterior papillary muscle thickening (r = - 0.38 and r =
-0.49, respectively). In group 2 dogs, MR did not occur in the presence of
either PMD or akinesia of the immediately adjacent LV myocardium. MR
occurred only when global LV dysfunction was produced (with the papillary
muscle function intact), and its severity correlated inversely with global
LV function (r = -0.92 with LV dP/dt and r = -0.86 with global LV
thickening, respectively). There was poor correlation between the degree of
MR and thickening of the anterior and posterior papillary muscles (r =
-0.24 and r = -0.38, respectively). In both groups of dogs, MR was
associated with incomplete mitral leaflet closure (IMLC), and the severity
of MR correlated linearly with the degree of IMLC (r = 0.98). MR was never
associated with mitral valve prolapse. In the group 3 dogs, despite more
inhomogeneous flow during ischemia to the anterior compared with the
posterior papillary muscle, mean thickening of these muscles was similar (3
+/- 10% and 3 +/- 4%, respectively). Furthermore, there was minimal
variability in thickening between different parts of the muscles (3 +/- 2%
and 5 +/- 3%, respectively). CONCLUSIONS. It is concluded that PMD and/or
dysfunction of the immediately adjacent LV myocardium does not result in
MR. MR occurs during ischemia only when global LV function is affected,
even when thickening of the papillary muscles and the immediately adjacent
LV remains intact. MR in this situation is related to IMLC; the greater the
degree of IMLC, the greater the MR. These findings suggest that the
mechanism of ischemic MR is not related to PMD. There may also be important
therapeutic implications of these findings.
ARTICLES
Mechanism of ischemic mitral regurgitation. An experimental evaluation
Department of Medicine, University of Virginia School of Medicine, Charlottesville 22908.
This article has been cited by other articles:
 |
|
 |
|
  T. H Marwick, P. Lancellotti, and L. Pierard Ischaemic mitral regurgitation: mechanisms and diagnosis Heart, October 15, 2009; 95(20): 1711 - 1718. [Full Text] [PDF]
|
|
|
|
 |
|
 M. V. Badiwala, S. Verma, and V. Rao Surgical Management of Ischemic Mitral Regurgitation Circulation, September 29, 2009; 120(13): 1287 - 1293. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Prucz, E. S. Weiss, and J. V. Conte Reply Ann. Thorac. Surg., August 1, 2009; 88(2): 709 - 709. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Dal-Bianco, E. Aikawa, J. Bischoff, J. L. Guerrero, M. D. Handschumacher, S. Sullivan, B. Johnson, J. S. Titus, Y. Iwamoto, J. Wylie-Sears, et al. Active Adaptation of the Tethered Mitral Valve: Insights Into a Compensatory Mechanism for Functional Mitral Regurgitation Circulation, July 28, 2009; 120(4): 334 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Donato, S. Castelvecchio, T. Kukulski, C. Bussadori, F. Giacomazzi, A. Frigiola, and L. Menicanti Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival. Ann. Thorac. Surg., February 1, 2009; 87(2): 455 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Armen, R. Vandse, J. A. Crestanello, S. V. Raman, K. M. Bickle, and N. S. Nathan Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography Eur J Echocardiogr, January 1, 2009; 10(1): 74 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. B. Prucz, E. S. Weiss, N. D. Patel, L. U. Nwakanma, A. S. Shah, and J. V. Conte The Impact of Surgical Ventricular Restoration on Mitral Valve Regurgitation Ann. Thorac. Surg., September 1, 2008; 86(3): 726 - 734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. B. Prucz, E. S. Weiss, N. D. Patel, L. U. Nwakanma, W. A. Baumgartner, and J. V. Conte Coronary Artery Bypass Grafting With or Without Surgical Ventricular Restoration: A Comparison Ann. Thorac. Surg., September 1, 2008; 86(3): 806 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J-M Song, M-J Kim, Y-J Kim, S-H Kang, J-J Kim, D-H Kang, and J-K Song Three-dimensional characteristics of functional mitral regurgitation in patients with severe left ventricular dysfunction: a real-time three-dimensional colour Doppler echocardiography study Heart, May 1, 2008; 94(5): 590 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato Ischemic mitral regurgitation: mechanisms and echocardiographic classification Eur J Echocardiogr, March 1, 2008; 9(2): 207 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Beeri, C. Yosefy, J. L. Guerrero, F. Nesta, S. Abedat, M. Chaput, F. del Monte, M. D. Handschumacher, R. Stroud, S. Sullivan, et al. Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 476 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Peteiro, I. Bendayan, J. Marinas, R. Campos, B. Bouzas, and A. Castro-Beiras Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: A follow-up study of 1.7 {+/-} 1.5 years Eur J Echocardiogr, January 1, 2008; 9(1): 18 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Di Donato, S. Castelvecchio, J. Brankovic, C. Santambrogio, V. Montericcio, and L. Menicanti Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1548 - 1553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Joudinaud, C. L. Kegel, E. M. Flecher, P. A. Weber, E. Lansac, U. Hvass, and C. M.G. Duran The papillary muscles as shock absorbers of the mitral valve complex. An experimental study Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 96 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Daimon, S. Fukuda, D. H. Adams, P. M. McCarthy, A. M. Gillinov, A. Carpentier, F. Filsoufi, V. M. Abascal, V. H. Rigolin, S. Salzberg, et al. Mitral Valve Repair With Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring for Ischemic Mitral Regurgitation: Early Echocardiographic Results From a Multi-Center Study Circulation, July 4, 2006; 114(1_suppl): I-588 - I-593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair? J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 565 - 573.e2.
|
|
|
|
|
|
S. Fukuda, R. Grimm, J.-M. Song, T. Kihara, M. Daimon, D. A. Agler, B. L. Wilkoff, A. Natale, J. D. Thomas, and T. Shiota Electrical Conduction Disturbance Effects on Dynamic Changes of Functional Mitral Regurgitation J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2270 - 2276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Giga, M. Ostojic, B. Vujisic-Tesic, A. Djordjevic-Dikic, J. Stepanovic, B. Beleslin, M. Petrovic, M. Nedeljkovic, I. Nedeljkovic, and N. Milic Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape Eur. Heart J., September 2, 2005; 26(18): 1860 - 1865. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-Y. Yu, M.-Y. Su, Y.-S. Chen, F.-Y. Lin, and W.-Y. I. Tseng Mitral tetrahedron as a geometrical surrogate for chronic ischemic mitral regurgitation Am J Physiol Heart Circ Physiol, September 1, 2005; 289(3): H1218 - H1225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Levine and E. Schwammenthal Ischemic Mitral Regurgitation on the Threshold of a Solution: From Paradoxes to Unifying Concepts Circulation, August 2, 2005; 112(5): 745 - 758. [Full Text] [PDF]
|
|
|
|
|
|
T. Uemura, Y. Otsuji, K. Nakashiki, S. Yoshifuku, Y. Maki, B. Yu, N. Mizukami, E. Kuwahara, S. Hamasaki, S. Biro, et al. Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling: Insights From Tissue Doppler Strain Imaging J. Am. Coll. Cardiol., July 5, 2005; 46(1): 113 - 119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-H. Kim, L. S.C. Czer, H. J. Soukiasian, M. De Robertis, K. E. Magliato, C. Blanche, S. S. Raissi, J. Mirocha, R. J. Siegel, R. M. Kass, et al. Ischemic Mitral Regurgitation: Revascularization Alone Versus Revascularization and Mitral Valve Repair Ann. Thorac. Surg., June 1, 2005; 79(6): 1895 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Daimon, T. Shiota, A. M. Gillinov, M. Hayase, M. Ruel, W. E. Cohn, S. J. Blacker, and J. R. Liddicoat Percutaneous Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation: A Real-Time Three-Dimensional Echocardiographic Study in an Ovine Model Circulation, May 3, 2005; 111(17): 2183 - 2189. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Watanabe, Y. Ogasawara, Y. Yamaura, T. Kawamoto, E. Toyota, T. Akasaka, and K. Yoshida Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography J. Am. Coll. Cardiol., March 1, 2005; 45(5): 763 - 769. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Bursi, M. Enriquez-Sarano, V. T. Nkomo, S. J. Jacobsen, S. A. Weston, R. A. Meverden, and V. L. Roger Heart Failure and Death After Myocardial Infarction in the Community: The Emerging Role of Mitral Regurgitation Circulation, January 25, 2005; 111(3): 295 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, B. M. Jackson, S. L. Moainie, Y. Enomoto, and R. C. Gorman Influence of inotropy and chronotropy on the mitral valve sphincter mechanism Ann. Thorac. Surg., March 1, 2004; 77(3): 852 - 857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Kaul The extents of mitral leaflet opening and closure are determined by left ventricular systolic function Heart, February 1, 2004; 90(2): 126 - 128. [Full Text] [PDF]
|
|
|
|
|
|
P. Lancellotti, F. Lebrun, and L. A. Pierard Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1921 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Levine and J. Hung Ischemic mitral regurgitation, the dynamic lesion: clues to the cure J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1929 - 1932. [Full Text] [PDF]
|
|
|
|
|
|
D. Paparella, L. L. Mickleborough, S. Carson, and J. Ivanov Mild to moderate mitral regurgitation in patients undergoing coronary bypass grafting: effects on operative mortality and long-term significance Ann. Thorac. Surg., October 1, 2003; 76(4): 1094 - 1100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S E Karagiannis, G T Karatasakis, N Koutsogiannis, G D Athanasopoulos, and D V Cokkinos Increased distance between mitral valve coaptation point and mitral annular plane: significance and correlations in patients with heart failure Heart, October 1, 2003; 89(10): 1174 - 1178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Messas, B. Pouzet, B. Touchot, J. L. Guerrero, G. J. Vlahakes, M. Desnos, P. Menasche, A. Hagege, and R. A. Levine Efficacy of Chordal Cutting to Relieve Chronic Persistent Ischemic Mitral Regurgitation Circulation, September 9, 2003; 108(90101): II-111 - 115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kwan, T. Shiota, D. A. Agler, Z. B. Popovic, J. X. Qin, M. A. Gillinov, W. J. Stewart, D. M. Cosgrove, P. M. McCarthy, and J. D. Thomas Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation: Real-Time Three-Dimensional Echocardiography Study Circulation, March 4, 2003; 107(8): 1135 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, D. T. Lai, F. Tibayan, D. Liang, G. T. Daughters, P. Dagum, M. K. Zasio, S. Lo, T. Hastie, N. B. Ingels Jr, et al. Ischemia in three left ventricular regions: Insights into the pathogenesis of acute ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 559 - 569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Picard, R. Davidoff, L. A. Sleeper, L. A. Mendes, C. R. Thompson, V. Dzavik, R. Steingart, K. Gin, H. D. White, J. S. Hochman, et al. Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock Circulation, January 21, 2003; 107(2): 279 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kumanohoso, Y. Otsuji, S. Yoshifuku, K. Matsukida, C. Koriyama, A. Kisanuki, S. Minagoe, R. A. Levine, and C. Tei Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: Quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 135 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
|
|
|
|
|
|
J. Hung, J. L. Guerrero, M. D. Handschumacher, G. Supple, S. Sullivan, and R. A. Levine Reverse Ventricular Remodeling Reduces Ischemic Mitral Regurgitation: Echo-Guided Device Application in the Beating Heart Circulation, November 12, 2002; 106(20): 2594 - 2600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Lai, T. A. Timek, F. A. Tibayan, G. R. Green, G. T. Daughters, D. Liang, N. B. Ingels Jr, and D. C. Miller The effects of mitral annuloplasty rings on mitral valve complex 3-D geometry during acute left ventricular ischemia Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 808 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, D. T. Lai, F. Tibayan, D. Liang, F. Rodriguez, G. T. Daughters, P. Dagum, N. B. Ingels Jr, and C. Miller Annular Versus Subvalvular Approaches to Acute Ischemic Mitral Regurgitation Circulation, September 24, 2002; 106(12_suppl_1): I-27 - I-32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Menicanti, M. Di Donato, A. Frigiola, G. Buckberg, C. Santambrogio, M. Ranucci, and D. Santo Ischemic mitral regurgitation: Intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration J. Thorac. Cardiovasc. Surg., June 1, 2002; 123(6): 1041 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Otsuji, T. Kumanohoso, S. Yoshifuku, K. Matsukida, C. Koriyama, A. Kisanuki, S. Minagoe, R. A. Levine, and C. Tei Isolated annular dilation does not usually cause important functional mitral regurgitation: Comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1651 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Messas, J. L. Guerrero, M. D. Handschumacher, C.-M. Chow, S. Sullivan, E. Schwammenthal, and R. A. Levine Paradoxic Decrease in Ischemic Mitral Regurgitation With Papillary Muscle Dysfunction: Insights From Three-Dimensional and Contrast Echocardiography With Strain Rate Measurement Circulation, October 16, 2001; 104(16): 1952 - 1957. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Messas, J. L. Guerrero, M. D. Handschumacher, C. Conrad, C.-M. Chow, S. Sullivan, A. P. Yoganathan, and R. A. Levine Chordal Cutting: A New Therapeutic Approach for Ischemic Mitral Regurgitation Circulation, October 16, 2001; 104(16): 1958 - 1963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, P. Dagum, D. T. Lai, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Pathogenesis of Mitral Regurgitation in Tachycardia-Induced Cardiomyopathy Circulation, September 18, 2001; 104 (2009): I-47 - I-53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Otsuji, M. D. Handschumacher, N. Liel-Cohen, H. Tanabe, L. Jiang, E. Schwammenthal, J. L. Guerrero, L. A. Nicholls, G. J. Vlahakes, and R. A. Levine Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation J. Am. Coll. Cardiol., February 1, 2001; 37(2): 641 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. M. Lai, T. A. Timek, P. Dagum, G. R. Green, J. R. Glasson, G. T. Daughters, D. Liang, N. B. Ingels Jr, and D. C. Miller The effects of ring annuloplasty on mitral leaflet geometry during acute left ventricular ischemia J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 966 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Liel-Cohen, J. L. Guerrero, Y. Otsuji, M. D. Handschumacher, L. G. Rudski, P. R. Hunziker, H. Tanabe, M. Scherrer-Crosbie, S. Sullivan, and R. A. Levine Design of a New Surgical Approach for Ventricular Remodeling to Relieve Ischemic Mitral Regurgitation : Insights From 3-Dimensional Echocardiography Circulation, June 13, 2000; 101(23): 2756 - 2763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Timek, J. R. Glasson, P. Dagum, G. R. Green, J. F. Nistal, M. Komeda, G. T. Daughters, A. F. Bolger, L. E. Foppiano, N. B. Ingels Jr, et al. RING ANNULOPLASTY PREVENTS DELAYED LEAFLET COAPTATION AND MITRAL REGURGITATION DURING ACUTE LEFT VENTRICULAR ISCHEMIA J. Thorac. Cardiovasc. Surg., April 1, 2000; 119(4): 774 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
|
|
|
|
|
|
S. L. Nielsen, H. Nygaard, A. A. Fontaine, J. M. Hasenkam, S. He, N. T. Andersen, and A. P. Yoganathan Chordal force distribution determines systolic mitral leaflet configuration and severity of functional mitral regurgitation J. Am. Coll. Cardiol., March 1, 1999; 33(3): 843 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hung, Y. Otsuji, M. D. Handschumacher, E. Schwammenthal, and R. A. Levine Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation: Physiologic insights from the proximal flow convergence technique J. Am. Coll. Cardiol., February 1, 1999; 33(2): 538 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Firoozan, K. Wei, A. Linka, D. Skyba, N. C. Goodman, and S. Kaul A canine model of chronic ischemic cardiomyopathy: characterization of regional flow-function relations Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H446 - H455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Rosario, L. W. Stevenson, S. D. Solomon, R. T. Lee, and S. C. Reimold The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1819 - 1824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Otsuji, D. Gilon, L. Jiang, S. He, M. Leavitt, M. J. Roy, M. J. Birmingham, and R. A. Levine Restricted diastolic opening of the mitral leaflets in patients with left ventricular dysfunction: evidence for increased valve tethering J. Am. Coll. Cardiol., August 1, 1998; 32(2): 398 - 404. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Glasson, M. Komeda, G. T. Daughters, A. F. Bolger, M. O. Karlsson, L. E. Foppiano, M. Hayase, S. N. Oesterle, N. B. Ingels Jr., and D. C. Miller Early systolic mitral leaflet "loitering" during acute ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., August 1, 1998; 116(2): 193 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. He, A. A. Fontaine, E. Schwammenthal, A. P. Yoganathan, and R. A. Levine Integrated Mechanism for Functional Mitral Regurgitation : Leaflet Restriction Versus Coapting Force: In Vitro Studies Circulation, September 16, 1997; 96(6): 1826 - 1834. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Otsuji, M. D. Handschumacher, E. Schwammenthal, L. Jiang, J.-K. Song, J. L. Guerrero, G. J. Vlahakes, and R. A. Levine Insights From Three-Dimensional Echocardiography Into the Mechanism of Functional Mitral Regurgitation : Direct In Vivo Demonstration of Altered Leaflet Tethering Geometry Circulation, September 16, 1997; 96(6): 1999 - 2008. [Abstract] [Full Text]
|
|
|
|
|
|
M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
|
|
|
|
|
|
J. R. Glasson, M. Komeda, G. T. Daughters II, A. F. Bolger, A. MacIsaac, S. N. Oesterle, N. B. Ingels Jr, and D. C. Miller Three-Dimensional Dynamics of the Canine Mitral Annulus During Ischemic Mitral Regurgitation Ann. Thorac. Surg., October 1, 1996; 62(4): 1059 - 1067. [Abstract] [Full Text]
|
|
|
|
|
|
J. H. Gorman III, K. B. Gupta, J. T. Streicher, R. C. Gorman, B. M. Jackson, M. B. Ratcliffe, D. K. Bogen, and L. H. Edmunds Jr. Dynamic Three-Dimensional Imaging of the Mitral Valve and Left Ventricle by Rapid Sonomicrometry Array Localization J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 712 - 726. [Abstract] [Full Text]
|
|
|
|
|
|
R. C Gorman, J. S McCaughan, M. B Ratcliffe, K. B Gupta, J. T Streicher, V. A Ferrari, M. G St. John-Sutton, D. K Bogen, and L. H. Edmunds Jr. Pathogenesis of acute ischemic mitral regurgitation in three dimensions J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 684 - 693. [Abstract] [Full Text]
|
|
|
|
|
|
R. A. Levine, G. J. Vlahakes, X. Lefebvre, J. L. Guerrero, E. G. Cape, A. P. Yoganathan, and A. E. Weyman Papillary Muscle Displacement Causes Systolic Anterior Motion of the Mitral Valve : Experimental Validation and Insights Into the Mechanism of Subaortic Obstruction Circulation, February 15, 1995; 91(4): 1189 - 1195. [Abstract] [Full Text]
|
|