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Eur J Cardiothorac Surg 2007;31:961. doi:10.1016/j.ejcts.2007.01.058
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
Cardiac Surgery Unit, Civic Hospital - Brescia, Brescia, Italy
Received 29 January 2007; accepted 31 January 2007.
* Corresponding author. Address: Cardiac Surgery Unit, Civic Hospital - Brescia, Piazza Spedali Civili 1, 25125 Brescia, Italy. Tel.: +39 030 3995636; fax: +39 030 3995004. (Email: giudeci{at}libero.it).
Key Words: Dynamics of mitral valve annulus • Movement of mitral prosthesis • Mitral valve periprosthetic leakage
We thank Anderson and Lunkenheimer for the comments [1] about our recent paper [2]. As a matter of fact, we were well aware about the conceptual differences between interpretations of Lunkenheimer and colleagues [3] and Torrent-Guasp and colleagues in relation to myocardial fibre architecture [4]. However, it was far from our intention to be part of the debate or controversy regarding the presence of a unique ventricular band (Torrent-Guasp), or the multiplicity of the myocardial syncitium (Lunkenheimer), and, as such, totally unrelated to the scope of our study. Rather, we attempted to find potential explanations of our findings, based on established anatomical studies, experimental findings, or mere speculations about the mitral annulus–left ventricle interaction and relationship. Therefore, by stating ‘confirmed’ we meant to underline that Lunkenheimer and Torrent-Guasp both described the complex patterns of fibre disposition and segmental differences in terms of contractile activity or thickness along the wall of the ventricular base, and hence, along the mitral annulus. By stating ‘revised’, we meant that a different, therefore ‘revised’, opinion was provided by the group of Torrent-Guasp in the interpretation of the myocardial architecture. Again, since there was no clear objective to agree or disagree with these different interpretations, we did not venture into such a controversy. We, therefore, apologise for such a misunderstanding, but we are also aware that we are not dealing with a fashionable issue, rather an extremely important complication after mitral valve replacement (MVR).
Finally, we take advantage of this occasion to underline that the findings of our paper were in accordance with the ones described by Komoda and colleagues [5]. Besides the anti-physiological dynamics of the mitral valve annulus (MVA) after MVR and the obvious loss of the MVA saddle-shape, from the study of Komoda and colleagues, it is clear that the sectors of the MVA exposed to the highest mechanical stresses after MVR are the same in which, in our experience, the periprosthetic leakages have been more frequently observed. As far as Fig. 2 is concerned, it was meant to highlight the structural and functional modification of the MVA and its interaction with the ventricular base structures after valve replacement.
References
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