Effect of mitral valve geometry on valve competence

Abstract

The aim of the investigation was to vary certain geometrical features of the mitral valve in vitro, in order to understand their role in valve function. Geometrical changes to mitral valve components are known to affect valve function, but complete understanding of how geometrical changes influence valve function is far from complete. Test apparatus has been used to apply pressure to porcine mitral valves. Porcine mitral valve specimens were tested both in their intact state and with a specific aspect of their geometry altered. The geometric parameters of the mitral valve varied were (1) the length between the papillary muscles and the mitral annulus (termed the annulo-papillary length), (2) the diameter of the left ventricle at the level of the papillary muscles, and (3) the mitral annular area. Six specimens were tested for each parameter investigated. A minimum annulo-papillary length was necessary to allow chordae tendineae to pull on the valve leaflets in order to prevent mitral valve failure; increasing this length further improved valve closure. Over the experimental range tested, left ventricular dilation at the level of the papillary muscles did not induce failure (P not significant). Increasing the mitral annular area was found to induce failure (P = 0.030 and P = 0.018 for medium and large annular diameters, respectively). The results demonstrate the importance of the geometry of mitral valve components on its function, and give insights into further experiments required to provide further understanding of the role of mitral valve geometry in its function. The results demonstrate that this in vitro method can be used to vary selected features of the geometry of the mitral valve.