Collagen birefringence assessment in heart chordae tendineae through PS-OCT

Abstract

Degenerative mitral regurgitation is a serious and frequent human heart valve disease. Malfunctioning of this valve brings the left-sided heart through a significant increase of pressure and volume overload. Severe degenerative mitral incompetence generally requires surgical repair or valve replacement with a bioprosthesis or mechanical heart valve. Degenerative disease affects the leaflets or/and the chordae tendineae, which link both leaflets to the papillary muscles. During mitral valve surgical repair, reconstruction of the valve leaflets, annulus and chordae are provided to prevent postoperative recurrence of valve regurgitation. The operative evaluation of the diseased and apparently normal chordae tendineae mainly depends of the surgeon´s experience, without any other objective diagnosis tool. In this work, PS-OCT (Polarization Sensitive-Optical Coherence Tomography) is applied for the first time to evaluate the pathological condition of human chordae coming from the mitral valve. It consists on a prospective study to test the viability of this technique for the evaluation of the collagen core of chords. This core presents a strong birefringence due to the longitudinal and organized arrangement of its collagen bundles. Different densities and organizations of the collagen core translate into different birefringence indicators whose measurement become an objective marker of the core structure. Ex-vivo mitral degenerative chordae tendineae have been analyzed with PS-OCT. Intensity OCT is used to obtain complementary morphological information of the chords. Birefringence results correlate with the previously reported values for human tendinous tissue.