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Morphological three-dimensional analysis of papillary muscles in borderline left ventricles

Published online by Cambridge University Press:  27 March 2017

Mari N. Velasco Forte ,
Mohamed Nassar ,
Nick Byrne ,
Miguel Silva Vieira ,
Israel V. Pérez ,
Bram Ruijsink ,
John Simpson  and
Tarique Hussain
Mari N. Velasco Forte
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Mohamed Nassar
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Cardiothoracic Surgery Department, Alexandria University, Alexandria, Egypt
Nick Byrne
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
Miguel Silva Vieira
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
Israel V. Pérez
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS), Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
Bram Ruijsink
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
John Simpson
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Tarique Hussain*
Affiliation:
Division of Imaging Science, King’s College London BHF Centre, Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Department of Pediatrics, UT Southwestern Medical Centre, Dallas, Texas, United States of America
*
Correspondence to: T. Hussain, University of Texas Southwestern Medical Center, Dallas Children’s Medical Center, D2.433 1935 Medical District Drive, Dallas, TX 75390, United States of America. Tel: (001) 214-456-0647; Fax: (001) 214-456-6154; E-mail: tarique@doctors.org.uk
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Abstract

Objective

Mitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles.

Methods

We carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups.

Results

All normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup.

Conclusions

The superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.

Keywords

Hypoplastic left heart syndromeborderline left ventriclecardiac magnetic resonancepapillary muscles
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1369 - 1376
Copyright
© Cambridge University Press 2017 

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