Echocardiographic assessment of ischemic mitral regurgitation

Dudzinski, David M.; Hung, Judy

doi:10.1186/1476-7120-12-46

Cited by 45 publications

(39 citation statements)

References 58 publications

(81 reference statements)

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“…Again, Zhang et al . and Dudzinsky and Hung found lower values, about 66 mm 2 . According to our theory and considering the antero‐posterior diameter, a loss in the proportion with the coaptation depth, as well as an increase in the expected tenting area, could represent the result of an initial leaflet tethering.…”

Section: Discussionsupporting

confidence: 82%

“…The Coaptation Triangle, also known as Tenting Area, is nowadays considered a very important element in the assessment of mitral geometry. By now, evaluating and measuring its components have become common practice in the study of valve anatomy and function …”

Section: Introductionmentioning

confidence: 99%

“…For many years, its height and its surface, known as tenting area, have been the most considered parameters. Recently, a growing interest has been born for the anterior and posterior cords, as well as for the angles formed by the anterior and posterior leaflets with the antero‐posterior diameter …”

Section: Introductionmentioning

confidence: 99%

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Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

Deorsola

Bellone

2017

Echocardiography

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Introduction The Coaptation Triangle, or Tenting Area, can be identified on long‐axis 2D images. Its assessment is a routine practice during echocardiographic mitral evaluation. The Golden Proportion is a particular geometric ratio between two segments. Its value is an irrational number, commonly rounded to 0.618 and showing unique geometrical/mathematical properties. Interestingly, its presence has been documented in an extremely variable number of natural settings. Hypothesizing the presence of the Golden Proportion in normal mitral anatomy, we examined the Coaptation Triangle of healthy valves to investigate such a theory. Methods and Results A total of 41 healthy adults, with normal mitral valves, underwent 2D echocardiography. Adequate images were chosen and loaded into custom software. Firstly, the Coaptation Triangle was manually drawn by the operator. Then, a second Coaptation Triangle, with the same base, but based on Golden Proportion, was automatically built by the software. Eventually, the two triangles were analyzed and compared. All retrieved measurements were investigated for differences and correlations. Ratios close to the Golden Proportion were found in several locations of the manually drawn Coaptation Triangle. On the other hand, comparing the manually drawn Coaptation Triangle with the automatically built one, no significant differences were revealed, and very strong correlations were demonstrated. Conclusion The Golden Proportion appears present in the geometry of normal mitral valves. Studying such an aspect and identifying disruption in anatomical proportions could improve early diagnosis of mitral alterations, and allows a more standardized follow‐up and help surgeons to plan a repair strategy, particularly quantifying the needed surgical modifications.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

Deorsola

Bellone

2017

Echocardiography

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“…The systolic MV orifice areas for both the FE deformed and true image model were measured and compared. The tenting area and volume during mid systole were also measured during systole 34,35 . The reaction force at the chordal origins, as well as the stress and strain on the leaflets were output from the FE simulation.…”

Section: Patient and Methodsmentioning

confidence: 99%

Finite Element Analysis of Patient-Specific Mitral Valve with Mitral Regurgitation

Pham

Kong

Martin

et al. 2017

Cardiovasc Eng Tech

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Functional mitral regurgitation (FMR) is a significant complication of left ventricular (LV) dysfunction and strongly associated with a poor prognosis. In this study, we developed a patient-specific finite element (FE) model of the mitral apparatus in a FMR patient which included: both leaflets with thickness, annulus, chordae tendineae, and chordae insertions on the leaflets and origins on the papillary muscles. The FE model incorporated human age- and gender- matched anisotropic hyperelastic material properties, and MV closure at systole was simulated. The model was validated by comparing the FE results from valve closure simulation with the in vivo geometry of the MV at systole. It was found that the FE model could not replicate the in vivo MV geometry without the application of tethering pre-tension force in the chordae at diastole. Upon applying the pre-tension force and performing model optimization by adjusting the chordal length, position, and leaflet length, a good agreement between the FE model and the in vivo model was established. Not only were the chordal forces high at both diastole and systole, but the tethering force on the anterior papillary muscle was higher than that of the posterior papillary muscle, which resulted in an asymmetrical gap with a larger orifice area at the anterolateral commissure resulting in MR. The analyses further show that high peak stress and strain were found at the chordal insertions where large chordal tethering forces were found. This study shows that the pre-tension tethering force plays an important role in accurately simulating the MV dynamics in this FMR patient, particularly in quantifying the degree of leaflet coaptation and stress distribution. Due to the complexity of the disease, the patient-specific computational modeling procedure of FMR patients presented should be further evaluated using a large patient cohort. However, this study provides useful insights into the MV biomechanics of a FMR patient, and could serve as a tool to assist in pre-operative planning for MV repair or replacement surgical or interventional procedures.

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“…Ischaemic mitral regurgitation (IMR) is an essential and underestimated clinical problem [1]. It is an important predictor of poor prognosis with increased risk of death [2].…”

Section: Introductionmentioning

confidence: 99%

Assessment of mitral apparatus in patients with acute inferoposterior myocardial infarction and ischaemic mitral regurgitation with two-dimensional echocardiography from anatomically correct imaging planes

2017

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Echocardiographic assessment of ischemic mitral regurgitation

Cited by 45 publications

References 58 publications

Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

Finite Element Analysis of Patient-Specific Mitral Valve with Mitral Regurgitation

Assessment of mitral apparatus in patients with acute inferoposterior myocardial infarction and ischaemic mitral regurgitation with two-dimensional echocardiography from anatomically correct imaging planes

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