Abstract
Defects of the mitral valve complex imply heart malfunction. The chordae tendineae (CTs) are tendinous strands connecting the mitral and tricuspid valve leaflets to the papillary muscles. These CTs are composed of organized, wavy collagen bundles, making them a strongly birefringent material. Disorder of the collagen structure due to different diseases (rheumatic, degenerative) implies the loss or reduction of tissue birefringence able to be characterized with Polarization Sensitive Optical Coherence Tomography (PS-OCT). PS-OCT is used to discriminate healthy from diseased chords, as the latter must be excised and replaced in clinical conventional interventions. PS-OCT allows to quantify birefringence reduction in human CTs affected by degenerative and rheumatic pathologies. This tissue optical property is proposed as a diagnostic marker for the identification of degradation of tendinous chords to guide intraoperative mitral valve surgery.
Highlights
Defects of the mitral valve imply heart malfunction and blood regurgitation, stressing the heart working conditions
During the measurement procedure with the commercial Optical Coherence Tomography (OCT) setup, the software provided by the manufacturer is implemented assuming that orthogonal polarization states in the detector are perfectly matched during the calibration procedure
Local estimate of birefringence can be calculated based on the rate of change of phase retardation with depth in images obtained with Polarization Sensitive Optical Coherence Tomography (PS-OCT) [26,27,28,29,30,31,32]
Summary
Defects of the mitral valve imply heart malfunction and blood regurgitation, stressing the heart working conditions. Degenerative disease of the mitral valve (DDMV) affects the chordae tendineae [4,5] When this occurs, the dense collagen tissue core evolves towards a loose tissue organization and the chordae may rupture [4]. PS-OCT is sensitive to the phase delay produced by birefringent tissues, such as the longitudinally ordered collagen fibers [13] This makes the CTs a strongly birefringent material. This feature is used as a degradation marker in the case of degenerative and rheumatic chordal disease The viability of this marker to identify degraded chords [23], in real time and avoiding histological studies, can turn PS-OCT into a useful and translatable in situ diagnostic tool during open surgery of the mitral valve
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