Mori T, Matsushita S, Morita T, Abudurezake A, Mochizuki J, Amano A. Evaluation of mitral chordae tendineae length using four-dimensional computed tomography. World J Cardiol 2024; 16(5): 274-281 [PMID: 38817650 DOI: 10.4330/wjc.v16.i5.274]
Corresponding Author of This Article
Satoshi Matsushita, MD, PhD, Associate Professor, Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan. saty-m@juntendo.ac.jp
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takuya Mori, Satoshi Matsushita, Terumasa Morita, Abulaiti Abudurezake, Atsushi Amano, Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
Takuya Mori, Department of Cardiovascular Surgery, JACCT Japan Animal Cardiovascular Care Team, Osaka 533-0033, Japan
Junji Mochizuki, Department of Radiology, Minamino Cardiovascular Hospital, Tokyo 192-0918, Japan
Author contributions: Mori T, Matsushita S, Morita T, and Amano A designed and conceived the study; Mori T collected and analyzed the data; Abudurezake A and Mochizuki J provided important data analysis support; Mori T wrote the paper; Matsushita S made critical revisions to the paper; all authors gave final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Juntendo University School of Medicine Ethics Committee (approval #2021080 Juntendo University Medical Ethics).
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed following the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Satoshi Matsushita, MD, PhD, Associate Professor, Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan. saty-m@juntendo.ac.jp
Received: November 14, 2023 Revised: February 16, 2024 Accepted: April 16, 2024 Published online: May 26, 2024 Processing time: 191 Days and 2.7 Hours
Abstract
BACKGROUND
Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation. Achieving precise measurements of artificial chordae tendineae length (CL) is an important factor in the procedure; however, no objective index currently exists to facilitate this measurement. Therefore, preoperative assessment of CL is critical for surgical planning and support. Four-dimensional x-ray micro-computed tomography (4D-CT) may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional (3D) evaluation compared to that with transthoracic echocardiography, a conventional inspection method.
AIM
To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.
METHODS
Eleven adults aged > 70 years without mitral valve disease were evaluated. A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization. The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image. The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP, respectively. The behavior and maximum lengths [cA (ma), cP (max)] were compared, and the correlation with body surface area (BSA) was evaluated.
RESULTS
In all cases, the mitral anterior leaflet chordae tendineae could be measured. In most cases, the cA and cP chordae tendineae could be measured visually. The mean cA (max) and cP (max) were 20.2 mm ± 1.95 mm and 23.5 mm ± 4.06 mm, respectively. cP (max) was significantly longer. The correlation coefficients (r) with BSA were 0.60 and 0.78 for cA (max) and cP (max), respectively. Both cA and cP exhibited constant variation in CL during systole, with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole. For cP, CL reached a plateau at 15% and remained elongated until end-systole, whereas for cA, after peaking at 15%, CL shortened slightly and then moved toward its peak again as end-systole approached.
CONCLUSION
The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.
Core Tip: Mitral regurgitation is one of the most common cardiac diseases. Although mitral valvuloplasty with artificial chordae tendineae is a standard procedure for surgical treatment, it has been difficult to evaluate the length and their motion preoperatively. In this study, we used four-dimensional computed tomography to establish accurate measurement of the length of chordae tendineae in the anterior leaflet of the mitral valve.
