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Should the Width of the Base of P2 be a Corner Stone for Mitral Valve Ring Annuloplasty?
Aram K. Smolinsky.
Assuta Medical Center, Tel Aviv, Israel.

Objective: The width of P2 (at its base) is not considered a clue to the understanding the underlining pathology of mitral valve regurgitation.One could assume that as the heart enlarges during the animal growth, the posterior ring/ P2 width will take a bigger share of it. We chose the model of the growing piglets. Not only is their heart considered to be very similar to humans, but within a year they weigh many times more. Our aim was to determine whether in the normal hearts, the heart growth influences the valve symmetry. Methods: Nineteen newborn piglets and six pigs form the basis for the measurements. The animals were weighed; their hearts were carefully dissected under operative microscope and weight separately. The measured parameters are the Inter trigone distance, (ITD) and the width of the base of P2, (WP2). They were compared to the same measurements in adult pigs. No animal was sacrificed for the purpose of this study. Results: Results and ratio are presented in the table: Conclusion: In the normal porcine heart, through times of tremendous growth, there is no significant change in valve symmetry. The width of the base of P2 segment of the mitral valve annulus maintains a constant ratio to the inter trigone distance, of around 0.9. As the common surgical findings in repairing the dilated hearts with mitral insufficiency is an enlarged posterior ring, one may conclude that shortening this segment to the ITD should be a major issue of the ring annuloplasty.

heart growth and valve symmetry
NumberBody weight mean (Kg)Heart weight mean (gr)WP2/ITD mean (SD)
Piglet(newborn)191.1337.930.85 (0.09)
Pigs63204250.93 (0.11)
Times growth28253.6
P non- paired t-testNS

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