On such occasion, transgastric approach should be employed.46) Transgastric view provides optimal image for quantitative analysis of the submitral apparatus (Fig. 6). A typical case

which underwent papillary head optimization procedure is shown in Fig. 7. PM heads in each PM are clearly visualized. With the aid of quantitative software Real View (YD, Nara, Japan), these images allows accurate measurement of the pre and postoperative U0126 distance Inhibitors,research,lifescience,medical between PM head and mid-anterior annulus and the tenting volume, etc (Fig. 8). In this particular patient, the distance between posterior PM head for anterior leaflet and mid-anterior annulus were shorten from 26.5 mm to 23.5 mm during the surgery. On the other hand the distance between anterior PM head for anterior leaflet and mid-anterior annulus only changed from 24.1 mm to 24.0 mm. The distances between

the mid anterior Inhibitors,research,lifescience,medical annulus and the both PM head for posterior leaflet were markedly reduced. Although MR was completely controlled in this patient, the colorized postoperative mitral leaflet by a Real View includes the red part in the lateral site, indicating slight residual tethering of leaflet in lateral site. Such information will assist further improvement of the quality of the surgery. Fig. 6 Visualizing the submitral structure by transgastric approach. Visualizing submitral structure at mid systole from a three-dimensional dataset acquired by transgastric Inhibitors,research,lifescience,medical approach using QLAB (Philips Medical Systems, Andver, MA, USA), with coronal section … Fig. 7 Pre- and postoperative observation of papillary heads optimization method. Postoperative connected papillary muscle head for anterior leaflet and for posterior Inhibitors,research,lifescience,medical leaflet of each papillary muscle by papillary heads optimization procedure is clearly visualized … Fig.

8 Quantitative analysis of submitral structure. With the aid of quantitative Inhibitors,research,lifescience,medical software, acquired three-dimensional volume dataset allows accurate measurement of the pre and postoperative distance between papillary muscle head and mid-anterior annulus and … SUMMARY Three dimensional echocardiography plays an essential role to understand the geometry of mitral valve complex, including PM, PM head division, chordae tendineae, leaflets and annulus and contributes greatly to decision making of the surgical strategy in functional MR and its postoperative assessment.

LVNC is a rare congenital cardiomyopathy characterized by multiple prominent trabeculations with deep AV-951 intertrabecular recesses.1) An arrest of compaction of the developing myocardium is strongly suggested as the probable mechanism of LVNC.1),9) Recently, the American Heart Association classified LVNC as a primary genetic cardiomyopathy.13) In contrast, the European Society of Cardiology considers LVNC to be an “unclassified cardiomyopathy”.14) Multiple diagnostic criteria for LVNC have been proposed on the basis of echocardiography and cardiac MRI findings. The echocardiographic criteria suggested by Jenni et al.