Author + information
- Received November 8, 2016
- Revision received February 20, 2017
- Accepted March 10, 2017
- Published online May 17, 2017.
- Andrea Colli, MD, PhDa,∗ (, )
- Fabio Zucchetta, MDa,
- Chad Kliger, MDb,
- Roberto Bellu, MDb,
- Marco Francone, MDc,
- Pietro Sedati, MDd,
- Vladimir Jelnin, MDe,
- Carlos E. Ruiz, MD, PhDe,
- Erica Manzan, MDa,
- Laura Besola, MDa,
- Eleonora Bizzotto, MDa and
- Gino Gerosa, MDa
- aDepartment of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- bLenox Hill Heart and Vascular Institute of New York, Hofstra School of Medicine, New York, New York
- cDepartment of Radiology, Sapienza University of Rome, Rome, Italy
- dDepartment of Radiology “Campus Bio-Medico” University, Rome, Italy
- eStructural and Congenital Heart Center, Hackensack University Medical Center Heart and Vascular Hospital and The Joseph M. Sanzari Children’s Hospital, Seton Hall University, Hackensack School of Medicine, Hackensack, New Jersey
- ↵∗Address for correspondence:
Dr. Andrea Colli, Cardiac Surgery Unit, Department of Cardiology, Thoracic and Vascular Sciences. University of Padova Medical School, Via Giustiniani, 2, 35127 Padova, Italy.
- computed tomography
- degenerative mitral valve
- mitral valve
- mitral valve regurgitation
- mitral valve repair
The advent of transapical echocardiography-guided mitral valve (MV) repair with implantation of polytetrafluoroethylene neochordae (NeoChord, St. Louis Park, Minnesota) has identified some critical aspects of the procedure that require accurate understanding of cardiac anatomy (1,2). In particular, transapical access, used for transcatheter aortic valve replacement, does not provide direct alignment with the MV, which is more posterior with respect to the aortic valve (Figure 1). Thus, posterolateral ventricular access provides a better approach to the MV, reducing the risk of the device interfering with the native subvalvular apparatus and enabling a more physiological axis orientation of implanted neochordae (Figure 2) (1,2). Cardiac computed tomography has recently been used as an additional tool for pre-operative procedure planning (Figure 3, Online Video 1) and for post-operative assessment of implanted neochordae (Figures 4 and 5, Online Videos 2, 3, 4, and 5). Ideal access can be identified by projecting the desired neochordae trajectory inside the left ventricle, starting from the diseased MV leaflet toward the left ventricular epicardial surface between the papillary muscles.
For accompanying videos and their legends, please see the online version of this article.
The Department of Cardiac, Thoracic and Vascular Sciences acquired the Aquarius (TeraRecon) software with a restricted grant from University of Padua, Italy (Bando Grandi Attrezzature 2015). Dr. Colli has been a proctor for and received travel grants from Neochord. Drs. Zucchetta, Manzan, Besola, Bizzotto, and Gerosa have received travel grants from Neochord. Dr. Kliger has received speaking honoraria from Philips Healthcare and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 8, 2016.
- Revision received February 20, 2017.
- Accepted March 10, 2017.
- 2017 American College of Cardiology Foundation
- Colli A.,
- Zucchetta F.,
- Torregrossa G.,
- et al.
- Colli A.,
- Manzan E.,
- Fabio F.Z.,
- et al.