Description of regional mitral annular nonplanarity in healthy human subjects: A novel methodology

Ryan, Liam; Jackson, Benjamin M.; Enomoto, Yoshiharu; Parish, Landi M.; Plappert, Theodore; John-Sutton, Martin G. St.; Gorman, Robert C.; Gorman, Joseph H.

doi:10.1016/j.jtcvs.2007.04.001

Cited by 51 publications

(49 citation statements)

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“…However, in a recent RT3DE study by Maffessanti et al, 8 AHCWR in control subjects was only 12.7%. Other RT3DE studies 10,16 showed that AHCWR in normal humans during systole is about 20%≈26%. The normal range of AHCWR in our larger study population values is ≈15% to 33% (mean±SD, 23.7±5.4%).…”

Section: Discussionmentioning

confidence: 95%

“…It is also questionable whether annular height measurements by echocardiography and magnetic resonance are interchangeable, given that the annular height measured by the Ennis group was also greater than that measured by other investigators using 3D echocardiography. 8,10,15,16 Without a normal reference group, it is difficult to conclude whether annular height was reduced, increased, or normal in the MVP subjects in the Ennis et al 23 study. In contrast, Mahmood et al 24 reported a larger nonplanarity angle (another measure of annular nonplanarity) in 40 MVP patients (133°) compared with control subjects (127°).…”

Section: Discussionmentioning

confidence: 97%

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Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

et al. 2013

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Background— Few data exist on the relation of the 3-dimensional morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse. Methods and Results— Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 112 subjects, including 36 patients with mitral valve prolapse and significant MR (≥3+; MR+ group), 32 patients with mitral valve prolapse but no or mild MR (≤2+; MR− group), 12 patients with significant MR resulting from nonprolapse pathologies (nonprolapse group), and 32 control subjects. The 3-dimensional geometry of mitral valve apparatus was measured with dedicated quantification software. Compared with the normal and MR− groups, the MR+ group had more dilated mitral annulus ( P <0.0001), a reduced annular height to commissural width ratio (AHCWR) ( P <0.0001) indicating flattening of annular saddle shape, redundant leaflet surfaces ( P <0.0001), greater leaflet billow volume ( P <0.0001) and billow height ( P <0.0001), longer lengths from papillary muscles to coaptation ( P <0.0001), and more frequent chordal rupture ( P <0.0001). Prevalence of chordal rupture increased progressively with annulus flattening (7% versus 24% versus 42% for AHCWR >20%, 15%–20%, and <15%, respectively; P =0.004). Leaflet billow volume increased exponentially with decreasing AHCWR in patients without chordal rupture ( r 2 =0.66, P <0.0001). MR severity correlated strongly with leaflet billow volume ( r 2 =0.74, P <0.0001) and inversely with AHCWR ( r 2 =0.44, P <0.0001). In contrast, annulus dilatation but not flattening occurred in nonprolapse MR patients. An AHCWR <15% (odds ratio=7.1; P =0.0004) was strongly associated with significant MR in mitral valve prolapse. Conclusion— Flattening of the annular saddle shape is associated with progressive leaflet billowing and increased frequencies of chordal rupture and may be important in the pathogenesis of MR in mitral valve prolapse.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

et al. 2013

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“…The first description of the 3D shape of the mitral annulus was made by Levine and colleagues using first-generation 3DE scanning [5]. Annular geometry was further examined by several other groups using real-time 3DE imaging with state-of-the-art matrix array transducers [11,15-17]. Sonomicrometric studies in sheep have demonstrated the conservation of mitral annular nonplanarity across species [6].…”

Section: Commentmentioning

confidence: 99%

“…The first saddle shaped rings were based on animal studies with sonomicrometry [10]. Second generation designs were created using data developed by our group’s application of novel real-time 3DE image analysis techniques to the human valve [11]. …”

Section: Introductionmentioning

confidence: 99%

Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis

Pouch¹,

Vergnat²,

McGarvey³

et al. 2014

The Annals of Thoracic Surgery

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Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of annular geometry with quantitative imaging techniques. In this work, we present an automated 3D echocardiographic (3DE) image analysis method that can be used to statistically assess variability in normal mitral annular geometry to support advancement in annuloplasty ring design. Methods 3D patient-specific models of the mitral annulus were automatically generated from 3DE images acquired from subjects with normal mitral valve structure and function. Geometric annular measurements including annular circumference (AC), annular height (AH), septolateral diameter (SLD), intercommissural width (ICW), and the AH to ICW ratio (AHCWR) were automatically calculated. A mean 3D annular contour was computed, and principal component analysis (PCA) was used evaluate variability in normal annular shape. Results The following mean ± standard deviations were obtained from 3DE image analysis: 107.0 ± 14.6 mm (AC), 7.6 ± 2.8 mm (AH), 28.5 ± 3.7 mm (SLD), 33.0 ± 5.3 mm (ICW), and 22.7 ± 6.9 % (AHCWR). PCA indicated that shape variability was primarily related to overall annular size, with more subtle variation in the skewness and height of the anterior annular peak, independent of annular diameter. Conclusions Patient-specific 3DE-based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral annular geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal geometry.

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“…[11][12][13][14][15] Traditionally, the non-planarity or the saddle shape of the MV annulus is evaluated offline by transferring data acquired during 3D TEE to Matlab software (Math Works, Natick, MA, USA) for measuring the annular height commissural width ratio (AHCWR). [16] Recently, mitral annular non-planarity has been described as the echocardiographically measured non-planarity angle (NPA) with 3D datasets acquired using TEE. [17] The NPA is defined as an angle subtended by anterior and posterior landmarks (peaks of the horns of the AML and PML) at the commissural diameter.…”

mentioning

confidence: 99%

The saddle shape of the mitral valve: More than just a shape

Neema

2013

Ann Card Anaesth

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Description of regional mitral annular nonplanarity in healthy human subjects: A novel methodology

Cited by 51 publications

References 20 publications

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis

The saddle shape of the mitral valve: More than just a shape

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