Analysis of Shape and Motion of the Mitral Annulus in Subjects With and Without Cardiomyopathy by Echocardiographic 3-Dimensional Reconstruction

Flachskampf, Frank A.; Chandra, Shalabh; Gaddipatti, Ajeetkumar; Levine, Robert A.; Weyman, Arthur E.; Ameling, Walter; Hanrath, Peter; Thomas, James D.

doi:10.1067/mje.2000.103878

Cited by 139 publications

(91 citation statements)

References 12 publications

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“…Its profile is saddle shaped and changes dynamically during the cardiac cycle (Flachskampf et al 2000). When observed from an atrial view, the annulus appears almost elliptical; for this reason, its extent is often described in terms of its two main diameters, the septolateral and commissure-commissure (CC) ones, whose extent changes from diastole to systole (Ormiston et al 1981;Fyrenius et al 2001).…”

Section: (I) the Annulusmentioning

confidence: 99%

Mitral valve finite-element modelling from ultrasound data: a pilot study for a new approach to understand mitral function and clinical scenarios

Votta

Caiani

Veronesi

et al. 2008

Phil. Trans. R. Soc. A.

108

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In the current scientific literature, particular attention is dedicated to the study of the mitral valve and to comprehension of the mechanisms that lead to its normal function, as well as those that trigger possible pathological conditions. One of the adopted approaches consists of computational modelling, which allows quantitative analysis of the mechanical behaviour of the valve by means of continuum mechanics theory and numerical techniques. However, none of the currently available models realistically accounts for all of the aspects that characterize the function of the mitral valve. Here, a new computational model of the mitral valve has been developed from in vivo data, as a first step towards the development of patient-specific models for the evaluation of annuloplasty procedures. A structural finiteelement model of the mitral valve has been developed to account for all of the main valvular substructures. In particular, it includes the real geometry and the movement of the annulus and papillary muscles, reconstructed from four-dimensional ultrasound data from a healthy human subject, and a realistic description of the complex mechanical properties of mitral tissues. Preliminary simulations allowed mitral valve closure to be realistically mimicked and the role of annulus and papillary muscle dynamics to be quantified.

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Section: (I) the Annulusmentioning

confidence: 99%

Mitral valve finite-element modelling from ultrasound data: a pilot study for a new approach to understand mitral function and clinical scenarios

Votta

Caiani

Veronesi

et al. 2008

Phil. Trans. R. Soc. A.

108

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“…2,9,10 This improved technology demonstrates a sequence of normal mitral annulus conformational changes over the cardiac cycle. Although atrial contraction may theoretically affect annular shape, no change occurred between early and late diastole.…”

Section: Dynamics Of the Normal Annulusmentioning

confidence: 99%

“…Pilot studies performed 3D reconstruction of mitral structure, particularly with MR induced by ischemia 8,9 or cardiomyop-athy. 10 However, the annular geometry and dynamics with MR resulting from myxomatous valve disease (MVD) are uncertain, 11 despite the importance of annuloplasty in surgical treatment. 12 Chief reasons for the paucity of data on mitral annular dynamics were technical.…”

mentioning

confidence: 99%

Mitral Annular Dynamics in Myxomatous Valve Disease

et al. 2010

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Background-Mitral annulus is a complex structure of poorly understood physiology. Full-volume real-time 3-dimensional transesophageal echocardiography offers a unique opportunity to completely image and quantify mitral annulus size and motion. Methods and Results-Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 32 patients with myxomatous valve disease (MVD) and moderate to severe regurgitation, 15 normal control subjects, and 10 patients with ischemic mitral regurgitation of identical body surface area. Mitral annular dimensions (circumference, area, anteroposterior and intercommissural diameters, height, and ratio of height to intercommissural diameter ratio, which appraises annular saddle-shape depth) were measured throughout the cardiac cycle with dedicated quantification software. Compared with direct surgical measurement, 3-dimensional anterior annular dimension provided reliable measurements (mean difference, 0.1Ϯ0.1 mm; Pϭ0.73; 95% confidence interval, Ϯ4.4 mm). Annular dimensions were larger in MVD patients compared with control subjects in diastole (all PϽ0.05). Normal annulus displayed early-systolic anteroposterior (PϽ0.001) and area (Pϭ0.04) contraction, increased height (PϽ0.001), and deeper saddle shape (ratio of height to intercommissural diameter, 15Ϯ1% to 21Ϯ1%; PϽ0.001), whereas intercommissural diameter was unchanged (Pϭ0.30). In contrast, MVD showed early-systolic intercommissural dilatation (Pϭ0.02) and no area contraction (Pϭ0.99), height increase (Pϭ0.11), or saddle-shape deepening (Pϭ0.35). Late-systolic MVD annular saddle shape deepened but annular area excessively enlarged (PϽ0.04) as a result of persistent intercommissural widening (PϽ0.02). MVD annulus also contrasts with ischemic mitral regurgitation annulus, which, despite similar anteroposterior enlargement, is narrower and essentially adynamic. After MVD repair, the annulus remained dynamic without systolic saddle-shape accentuation (Pϭ0.30). Conclusions-Real-time 3-dimensional transesophageal echocardiography provides insights into normal, dynamic mitral annulus function with early-systolic area contraction and saddle-shape deepening contributing to mitral competency. MVD annulus is also dynamic but considerably different with loss of early-systolic area contraction and saddle-shape deepening despite similar magnitude of ventricular contraction, suggestive of ventricular-annular decoupling. Subsequent area enlargement may contribute to mitral incompetence. After mitral repair, MVD annulus remains dynamic without systolic saddle-shape accentuation. Thus, real-time 3-dimensional transesophageal echocardiography provides new insights that allow the refining of mitral pathophysiology concepts and repair strategies. (Circulation.

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“…In two-dimensional studies [67][68][69][70][71] , quantification of regional myocardial function is based on the measurement of the endocardial movement between systole and diastole, the technological advances being digital subtraction high frame rate echocardiography and segmental analysis of color kinesis images 72,73 . The also promising threedimensional echocardiography [45][46][47] has not yet entered daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…1). For each parameter in the longitudinal axis, the respective heterogeneity index regarding regional function and longitudinal global function (mitral annulus kinetics) [36][37][38][39][40][41][42][43][44][45][46][47] . The objectives of this study were to characterize left ventricular regional myocardial function by tissue Doppler echocardiography in a population of healthy adult volunteers and to assess the influence of age on regional myocardial function.…”

Section: Objective -To Characterize Left Ventricular Regional Myocardmentioning

confidence: 99%

Regional myocardial function in healthy adults: assessment through tissue Doppler echocardiography

Cardim¹,

Oliveira²,

Longo³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To characterize left ventricular regional myocardial function through tissue Doppler echocardiography in healthy adults and to assess the influence of aging in this function. METHODS: In 45 healthy volunteers divided in two groups (< 45 and > 45 years old) we assessed longitudinal and radial regional function (velocities, times intervals and velocity-time integrals). Data were compared in each group and between groups. RESULTS: Systolic function: a) longitudinal: higher velocities and integrals in lateral and inferior walls and in basal segments, with a trend to reduction of these parameters with aging; b) radial: higher basal velocities, no significant change with aging. Diastolic function: a) longitudinal: higher velocities in lateral and inferior walls and in basal segments. With aging e and e/a velocities and integrals decreased, a increased and older individuals showed lower percentage of segments with e/a >1; b) radial: aging was associated with lower e and higher a velocities. CONCLUSION: 1) Tissue Doppler echocardiography detects physiological differences between regional myocardial function of different ventricular segments, in velocities, times intervals and integrals, with physiological heterogeneity and asynchrony; 2) Many of these data are age dependent; 3) Our data contribute to define normal values, and may become useful when compared with data from populations with heart diseases

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Analysis of Shape and Motion of the Mitral Annulus in Subjects With and Without Cardiomyopathy by Echocardiographic 3-Dimensional Reconstruction

Cited by 139 publications

References 12 publications

Mitral valve finite-element modelling from ultrasound data: a pilot study for a new approach to understand mitral function and clinical scenarios

Mitral valve finite-element modelling from ultrasound data: a pilot study for a new approach to understand mitral function and clinical scenarios

Mitral Annular Dynamics in Myxomatous Valve Disease

Regional myocardial function in healthy adults: assessment through tissue Doppler echocardiography

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