Dynamic 3-Dimensional Echocardiographic Assessment of Mitral Annular Geometry in Patients With Functional Mitral Regurgitation

Khabbaz, Kamal R.; Mahmood, Feroze; Shakil, Omair; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Matyal, Robina; Panzica, Peter; Hess, Philip E.

doi:10.1016/j.athoracsur.2012.08.078

Cited by 52 publications

(37 citation statements)

References 34 publications

(36 reference statements)

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“…In recent years, there have been several studies on mitral valve structure. [5][6][7][8] However, most studies focused on one part of the mitral apparatus. Due to the complexity and delicacy of the mitral valve, assessing the apparatus quantitatively and comprehensively remains a considerable challenge for physicians.…”

Section: Itral Regurgitation (Mr) Is a Common Cardiac Diseasementioning

confidence: 99%

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Zhang

Qiu

et al. 2015

Int. Heart J.

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SummaryTo quantitatively assess the geometric changes in mitral valve apparatus in mitral regurgitation (MR) by dualsource computed tomography (DSCT) and to analyze its impact on MR.The study subjects consisted of 20 controls, 20 patients with mild MR, and 30 patients with moderate to severe MR, all of whom underwent DSCT. The geometric parameters of the mitral valve were measured by CT and compared among the 3 groups. The correlations between DSCT measurements and MR severity were also analyzed.As regurgitation worsened, our results showed progressive enlargements of the mitral annular area, anteroposterior diameter, and mitral valve tenting area at the central level. Moreover, a higher mitral valve sphericity index and longer distance between the heads of the papillary muscles reflected a more outward displacement of the papillary muscles. The mitral annular area and tenting area at the central level had strong correlations with regurgitation severity.DSCT is available to quantitatively assess mitral valve morphology and provide additional information regarding its geometry. The mitral annular area and tenting area at the central level were the strongest determinants of MR severity. Regardless of whether the regurgitation is caused by a primary anatomical abnormality of the mitral valve 2) or secondary to left ventricular dysfunction, 3,4) moderate to severe MR is associated with a lower survival rate. The progression of significant MR may result in pulmonary hypertension and heart failure.The mitral valve apparatus is a complex 3-dimensional structure consisting of the mitral annulus (MA), leaflet, chordae tendinae, papillary muscles (PMs), and the attached left ventricular wall. Every component works in a coordinated, precise manner to prevent blood flowing back into the left atrium during cardiac systole. A comprehensive, accurate assessment of the mitral apparatus is very important for determining the optimal treatment plan, deciding the timing of surgical intervention, and determining the prognosis. In recent years, there have been several studies on mitral valve structure. [5][6][7][8] However, most studies focused on one part of the mitral apparatus. Due to the complexity and delicacy of the mitral valve, assessing the apparatus quantitatively and comprehensively remains a considerable challenge for physicians.Coronary computed tomography (CT) angiography is currently used as an invasive tool to evaluate the coronary anatomy and exclude significant ischemic heart disease in patients referred for valvular surgery with high sensitivity and specificity.9-12) Recent advances in multi-detector CT (MDCT)/ dual-source CT (DSCT) have provided a better understanding and assessment of the heart valves, [13][14][15][16][17][18] with high spatial resolution, excellent image quality, and comprehensive cardiac data. Therefore, this study aimed to quantitatively assess the anatomy and geometry of the mitral valve apparatus using ECG-gated 64-slice DSCT.

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Section: Itral Regurgitation (Mr) Is a Common Cardiac Diseasementioning

confidence: 99%

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Zhang

Qiu

et al. 2015

Int. Heart J.

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“…MVR without preservation of the mitral apparatus and chordal structures is not recommended because preservation of the mitral apparatus has shown to preserve LV geometry and systolic function, and improve survival [73][74][75][76]. In FMR, operative mortality for MV surgery is approximately 3 %-4 % [77][78][79][80].…”

Section: Repair Vs MV Replacementmentioning

confidence: 99%

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

2014

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Functional mitral regurgitation (FMR) occurs when normal or nearly normal mitral leaflets are prevented from proper coaptation by underlying left ventricular (LV) dysfunction, mitral annular dilation, or both. FMR is associated with an adverse prognosis in nonischemic or ischemic LV dysfunction. Multiple studies have confirmed that even mild FMR portends a worse prognosis, and that the risk of FMR is independent of LV volumes and other clinical risk factors. FMR can be difficult to quantitate echocardiographically because it is load dependent and can vary considerably from exam to exam. There is a systematic tendency to underestimate FMR severity by echocardiography because the regurgitant orifice in FMR is typically elliptical, but the formula for calculating regurgitant orifice area assumes circular geometry. Treatment of FMR begins with guideline-directed medical therapy (GDMT) for LV dysfunction and heart failure, including cardiac resynchronization, if indicated. Revascularization should be considered for ischemic FMR, when indicated. Finally, mitral valve surgery should be considered in patients undergoing CABG in whom moderate or greater FMR is present, and also when severe symptomatic FMR persists despite optimal GDMT and revascularization. Percutaneous options for treatment of FMR are in development but are not currently approved in the US.

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“…Whereas conventional surgical ‘valve analysis’ is performed when the patient is on cardiopulmonary bypass under non-physiological circumstances, echocardiography provides anatomical information with a physiological perspective 52. TEE provides high-resolution dynamic 2D and 3D en face surgical views of the mitral valve, aortic and tricuspid valves that provide surgically relevant qualitative and quantitative information 23…”

Section: Current Applicationsmentioning

confidence: 99%

Perioperative transoesophageal echocardiography: current status and future directions

Mahmood

Shernan

2016

Heart

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Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions. Additionally, 3D imaging has facilitated the advent of minimally invasive and percutaneous interventions for structural heart disease. Information derived from TEE is routinely used to evaluate a patient's suitability for an intervention, provide guidance during the intervention and eventually comment on the quality and success of the procedure. Expertise in perioperative TEE is an integral component of a cardiac anaesthesiologist's skill sets. With structural heart disease interventions becoming more minimally invasive, the intraoperative guidance provided by TEE will continue to be a critical component of these procedures. With improving computational and processing power, the expectations from TEE will continue to be incremental in the perioperative arena.

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Dynamic 3-Dimensional Echocardiographic Assessment of Mitral Annular Geometry in Patients With Functional Mitral Regurgitation

Cited by 52 publications

References 34 publications

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

Perioperative transoesophageal echocardiography: current status and future directions

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