Only Neochordoplasty Achieves Physiological Trans-valvular Pressure Gradients After Repair Of Acute Posterior Leaflet Prolapse In Porcine Mitral Valves

Objective: Minimizing resection and preserving leaflet tissue has been previously shown to be beneficial for mitral valve function and leaflet kinematics after repair of acute posterior leaflet prolapse in porcine valves. We examined the effects of different additional methods of mitral valve repair (neochordoplasty, ring annuloplasty, edge-to-edge repair and triangular resection) on hemodynamics at different heart rates in an experimental model. Methods: Severe acute P2 prolapse was created in eight porcine mitral valves by resecting the posterior marginal chordae. Valve hemodynamics was quantified under pulsatile conditions in an in vitro heart simulator before and after surgical manipulation. Mitral regurgitation was corrected using four different methods of repair on the same valve: neochordoplasty with expanded polytetrafluoroethylene sutures alone and together with ring annuloplasty, edge-to-edge repair and triangular resection, both with non-restrictive annuloplasty. Residual mitral valve leak, trans-valvular pressure gradients, flow and cardiac output were measured at 60 and 80 beats/min. A validated statistical linear mixed model was used to analyze the effect of treatment. The p values were calculated using a two-sided Wald test. Results: Only neochordoplasty with expanded polytetrafluoroethylene sutures but without ring annuloplasty achieved similar hemodynamics compared to those of the native mitral valve (p range 0.071-0.901). Trans-valvular diastolic pressure gradients were within a physiologic range but significantly higher than those of the native valve following neochordoplasty with ring annuloplasty (p=0.000), triangular resection (p=0.000) and edge-to-edge repair (p=0.000). Neochordoplasty alone was significantly better in terms of hemodynamic than neochordoplasty with a ring annuloplasty (p=0.000). These values were stable regardless of heart rate or ring size. Conclusions: Neochordoplasty without ring annuloplasty is the only repair technique able to achieve almost native physiological hemodynamics after correction of leaflet prolapse in a porcine experimental model of acute chordal rupture.

Mitral valve prolapse and its relationship with stroke

The purpose of this study was to elucidate the relationship between mitral valve prolapse and stroke. A population-based historical cohort investigation was conducted among residents of Olmsted County, Minnesota who had an initial echocardiographic diagnosis of mitral valve prolapse from 1975 through 1989. This cohort (N = 1085) was followed for stroke outcomes using the resources of an operational medical record linkage system. There was an overall two-fold increase in the incidence of stroke among individuals with mitral valve prolapse relative to a standard population (standardized morbidity ratio = 2.12, 95% confidence limits = 1.33-3.21). When the data were partitioned by duration of follow-up from the diagnosis of mitral valve prolapse, or by the calendar years at echocardiographic diagnosis, respectively, the association between mitral valve prolapse and stroke was not modified. Mitral valve prolapse subjects 85 years and older were at highest increased risk of developing strokes relative to the general population (standardized morbidity ratio = 5.47, 95% confidence limits = 2.20-11.24). Coronary heart disease, atrial fibrillation, diabetes mellitus and hypertension, were unlikely to have confounded the association between mitral valve prolapse and stroke.^ The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 15 to 64 years, given survival to 15.2 years of follow-up, was 4.0%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 65 to 74 years, given survival to 11.2 years of follow-up, was 13.2%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 75 years and older, given survival to 6.7 years of follow-up, was 30.6%.^ Among individuals with mitral valve prolapse, age, diabetes, and atrial fibrillation were associated with an increased risk of stroke. Atrial fibrillation was associated with a four-fold rate of stroke and diabetes associated with a seven-fold rate of stroke.^ Findings from this research support the hypothesis that mitral valvular heart prolapse is linked with a stroke sequela. ^

Underground parking structure built with deep foundations and vault precast elements in Spain

In many cases the only places available for the construction of a new car park are the existing streets or roads. These streets may also have important or historic buildings very close to the structure, which means that they cannot be disturbed in any way during the construction of the parking structure. In many cases the only places available for the construction of a new car park are the existing streets or roads. These streets may also have important or historic buildings very close to the structure, which means that they cannot be disturbed in any way during the construction of the parking structure.

Late Gothic German Vault Design Methods and Its Relationship with Spanish Ribbed Vaults

The arrival of European master masons to Burgos and Toledo during the mid-fifteenth century was essential for the promotion of the late Gothic ribbed vault design techniques in Spain. The Antigua Chapel in Seville Cathedral, designed by the Spanish master mason Simón de Colonia on 1497, provides an outstanding case study on this subject. This vault is characterized by the interlacing of the ribs near the springing, reflecting the influence of German ribbed vault designs. This paper analyses the relationship between German ribbed vaults and their design methods with those of Spanish ribbed vaults; with particular attention to the presence of ribs that cut through one another above the springing, materialized in the work of Simón de Colonia. This characteristic is reflected in some manuscripts in the German area, like the Wiener Sammlungen (15th-16th centuries) and the Codex Miniatus 3 (ca. 1560-1570), but no Spanish documents of the same period make reference to it.

The Irregular Ribbed Vault of the Sacristy of the Cathedral of Saint-Jean Baptiste in Perpignan

The vault of the sacristy of the Cathedral of Saint-Jean Baptiste in Perpignan (France), constructed by the Majorcan architect Guillem Sagrera between 1433 and 1447, is an outstanding, yet strikingly unknown, example of rib vaulting. This paper analyzes the overall construction of the form of the vault, characterized by its highly irregular perimeter, with particular attention to an isolated decorated corbel which solves the problem of the wall support of a group of six ribs and is in stark contrast with the rest of the supports, which are completely unadorned. Given the extreme rigour of Sagrera in all his works (and this one in particular), this apparent “capriccio” must be justified not only by decorative or formal requirements, but also by the constructive logic of Gothic vaulting system

Construction of a Pendentive Grid Crossing Vault

Nuts & bolts of construction history : culture, technology and society :[proceedings of the Fourth International Congress on Construction History, Paris, 3-7 July 2012. ISBN: 978-2-7084-0929-3 . Vol 1 págs 81 a 88