In Vitro System for Measuring Chordal Force Changes Following Mitral Valve Patch Repair
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Attention toward optimization of mitral valve (MV) repair methods is increasing. Patch augmentation is one strategy utilized to correct functional mitral regurgitation or systolic anterior motion in complex MV repairs. This article describes a system for investigating the redistribution of chordae tendineae tension as a reflection of altered stress distribution of the valve leaflet following patch augmentation. An in vitro test setup was constructed to hold native porcine MVs containing an annulus and papillary muscle positioning system. The alterations caused by patch augmentation should be visual from both the atrial and ventricular views. Ventricular pressure was regulated stepwise in a range of 0–150 mmHg. To test the system, the anterior mitral leaflet was extended by a pericardial patch sutured to the mid/basal part of the leaflet, and the chordae tendineae force was measured as the ventricular pressure was applied. The system demonstrated the capacity to hold native porcine MVs and introducing patch repairs according to clinical practice. The porcine MV test setup indicated strong correlation between the forces in the MV secondary chordae tendineae and the applied transvalvular pressure, R2 = 0.95. This test setup proved the ability to obtain normal mid-systolic MV function, secondary chordae force measurements, and important preservation of the visual access: Hence, obtaining the pressure-force relationship as well as identifying any shift of the secondary chordae insertion point on the anterior leaflet relative to the coaptation zone was made possible.