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Comparative Study
. 2013 Jan;95(1):105-10.
doi: 10.1016/j.athoracsur.2012.08.078. Epub 2012 Oct 25.

Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation

Kamal R Khabbaz  1 , Feroze Mahmood, Omair Shakil, Haider J Warraich, Joseph H Gorman 3rd, Robert C Gorman, Robina Matyal, Peter Panzica, Philip E Hess
Affiliations
Comparative Study

Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation

Kamal R Khabbaz et al. Ann Thorac Surg. 2013 Jan.

Abstract

Background: Mitral valve (MV) annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV annular geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV annular geometry associated with FMR.

Methods: Intraoperative 3D transesophageal echocardiographic data obtained from 34 patients with FMR and 15 controls undergoing cardiac operations were dynamically analyzed for differences in mitral annular geometry with TomTec 4D MV Assessment 2.0 software (TomTec Imaging Systems GmbH, Munich, Germany).

Results: In patients with FMR, the mean mitral annular area (14.6 cm(2) versus 9.6 cm(2)), circumference (14.1 cm versus 11.4 cm), anteroposterior (4.0 cm versus 3.0 cm) and anterolateral-posteromedial (4.3 cm versus 3.6 cm) diameters, tenting volume (6.2 mm(3) versus 3.5 mm(3)) and nonplanarity angle (NPA) (154 degrees ± 15 versus 136 degrees ± 11) were greater at all points during systole compared with controls (p < 0.01). Vertical mitral annular displacement (5.8 mm versus 8.3 mm) was reduced in FMR compared with controls (p < 0.01).

Conclusions: There are significant differences in dynamic mitral annular geometry between patients with FMR and those without. We were able to analyze these changes in a clinically feasible fashion. Ready availability of this information has the potential to aid comprehensive quantification of mitral annular function and possibly assist in both clinical decision making and annuloplasty ring selection.

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Figures

FIGURE 1
FIGURE 1
In patients with functional mitral regurgitation, mitral annular area was larger (Panel A) and experienced a smaller delta change (Panel B), compared with controls. These differences were seen throughout systole. FMR: functional mitral regurgitation
FIGURE 2
FIGURE 2
Compared with controls, NPA is much greater in patients with functional mitral regurgitation, indicating a flatter and a less saddle-shaped mitral annulus (Panel A). Also, the delta change in NPA over systole is much lower in patients with functional mitral regurgitation (Panel B). A screenshot from TomTec© 4D MV Assessment 2.0 demonstrates the initial decrease in the saddle shape of the mitral annulus followed by an increase towards end systole (Panel C). FMR: functional mitral regurgitation
See this image and copyright information in PMC

References

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