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(Circulation. 2004;110:3088-3092.)
© 2004 American Heart Association, Inc.

Heart Failure

Percutaneous Mitral Annular Reduction Provides Continued Benefit in an Ovine Model of Dilated Cardiomyopathy

Melissa J. Byrne, BSc, BApSc; David M. Kaye, MB, BS, PhD; Mark Mathis, BSME; David G. Reuter, MD, BSME; Clif A. Alferness, BEE; John M. Power, BVSc, PhD

From the Department of Applied Cardiovascular Research (M.J.B., J.M.P.) and Wynn Department of Metabolic Cardiology (D.M.K.), Baker Heart Research Institute, Melbourne, Victoria, Australia; and Cardiac Dimensions Inc, Kirkland, Wash (M.M., D.G.R., C.A.A.).

Correspondence to John M. Power, BVSc, PhD, Department of Applied Cardiovascular Research, Baker Heart Research Institute, PO Box 6492, St Kilda Rd Central, Melbourne, Victoria 8008, Australia. E-mail john.power{at}baker.edu.au

Received January 16, 2004; de novo received March 25, 2004; revision received June 15, 2004; accepted June 21, 2004.

Background— Functional mitral valve regurgitation plays a key role in the symptomatic severity and progression of heart failure. In an ovine model of dilated cardiomyopathy, we examined the chronic functional consequences of mitral regurgitation reduction using a recently developed novel percutaneous mitral annular reduction (PMAR) device.

Methods and Results— Fourteen adult sheep were paced right ventricularly at 180 to 190 bpm for 5 weeks, leading to the development of moderate mitral valve regurgitation. After echocardiographic, hemodynamic, and neurohormonal analysis, 9 animals underwent PMAR. All animals were subsequently paced for another 28 days, and a final echocardiographic and hemodynamic study was conducted. Animals that had undergone PMAR showed significantly increased negative and positive dP/dt, whereas pulmonary capillary wedge pressure and mitral valve regurgitation were significantly reduced compared with those at device implant despite continued pacing. In conjunction, significant improvements in plasma norepinephrine and brain natriuretic peptide were apparent.

Conclusions— The application of PMAR in animals with pacing-induced dilated cardiomyopathy and functional mitral valve regurgitation resulted in continued improvements in hemodynamic and neurohormonal parameters.

Key Words: mitral valve • regurgitation • catheterization • cardiology • cardiomyopathy

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