Efficacy and Accuracy of Novel Automated Mitral Valve Quantification: Three‐Dimensional Transesophageal Echocardiographic Study

Kagiyama, Nobuyuki; Toki, Misako; Hara, Masahiko; Fukuda, B S Shuichiro; Aritaka, B S Shingo; Miki, Tomonori; Ohara, Minako; Hayashida, Akihiro; Hirohata, Atsushi; Yamamoto, Keizô; Yoshida, Kiyoshi

doi:10.1111/echo.13135

Cited by 33 publications

(18 citation statements)

References 27 publications

(45 reference statements)

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“…As previously reported by Kagiyama et al, MVN has been shown to have good inter‐observer agreement with automated and manual measurements as well as a reduction in time spent for analysis. We also believe that there is more consistency in selecting annular and commissural points using automated quantification.…”

Section: Discussionsupporting

confidence: 78%

The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

et al. 2019

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Background The effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation (MR) have not been well characterized. We evaluated acute changes in mitral annular shape and dimensions, and their effect on MR severity, in patients with functional and degenerative MR following MitraClip®. Methods Patients that underwent MitraClip® between January 2013 and May 2016 at our institution were retrospectively reviewed. Exclusions: inadequate images, prior mitral valve repair, and rapid atrial fibrillation. Intra‐procedure TEE 3D images acquired prior to and after implantation of MitraClip® were analyzed using software to model the mitral valve apparatus. Results Of seventy‐eight patients that underwent MitraClip® procedure, 60 were eligible. Mean age was 78.3 ± 11 years. Severe MR (4+) was present in 37 patients, moderately/severe MR (3+) in 23. All patients achieved MR reduction to ≤2. 3D annular circumference, bicommissural diameter, and anteroposterior diameter had a significant size reduction after MitraClip®. None of the mitral annular measures had significantly different mean change between the large and small MR change groups at the 0.05 significance level. Conclusions In patients with functional or degenerative MR, the MitraClip® significantly affect mitral annular dimensions; however, these changes do not correlate with the immediate MR reduction.

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Section: Discussionsupporting

confidence: 78%

The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

et al. 2019

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“…The MR grade was evaluated by measuring the color Doppler jet area or using the Doppler‐derived volumetric method or proximal isovelocity surface area method, according to previously published guidelines . A 3D‐TEE analysis was performed off‐line using the commercially available semiautomated software package Mitral Valve Navigation (Philips Medical Systems, Andover, MA), for which the accuracy and reproducibility of 3D quantification has been previously reported . The anterior mitral leaflet (AML) and PML angles were defined as the angles between the annular line and the line that joins the anterior/posterior annulus and coaptation point, respectively .…”

Section: Methodsmentioning

confidence: 99%

Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation

et al. 2019

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Background Surgical ring annuloplasty is generally performed in patients with symptomatic atrial functional mitral regurgitation (MR) caused by long‐standing atrial fibrillation (AF). However, its clinical results have not been well reported. Methods Twenty consecutive patients with atrial functional MR (mean age of 68 ± 9 years) and a left ventricular (LV) ejection fraction (EF) greater than 50% underwent mitral annuloplasty. Concomitant procedures included tricuspid valve surgery in 16 patients, AF ablation in 13 patients, and coronary artery bypass grafting in 2 patients. We reviewed the clinical outcomes of those patients and investigated the specific preoperative echocardiographic findings related to MR recurrence. Results At discharge, the mean left atrial (LA) volume index and mean tricuspid regurgitation peak gradient had significantly decreased from 94 ± 59 mL/m 2 to 58 ± 30 mL/m 2 and from 34 ± 11mm Hg to 23 ± 5mm Hg, respectively. During the follow‐up period of 28 ± 17 months, the New York Heart Association functional class significantly improved from 2.3 ± 0.6 to 1.3 ± 0.6. Four patients developed recurrent MR, and of those, two required reoperation. Those with recurrent MR had a significantly larger preoperative LV dimension than those without recurrent MR. Preoperative three‐dimensional transesophageal echocardiography was performed in 12 patients, revealing a greater degree of leaflet tethering in patients with recurrent MR than that in patients without recurrent MR. Conclusions In patients with the combination of atrial functional MR, left ventricular dilatation and excessive leaflet tethering, mitral annuloplasty alone may not be sufficient to achieve long‐term correction of MR.

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“…For intraoperative TEE assessment of residual MR, maximum regurgitant jet area (MRA) was used because quantification of residual MR, which is mostly less than mild, is difficult with the proximal isovelocity surface area method. In addition, 3D‐TEE analysis was performed off‐line using the commercially available semiautomated software package, MVN (Philips Medical Systems, Best, The Netherlands), whose accuracy and reproducibility of 3D quantification have been reported . Briefly, the diameters of the mitral annulus were measured between A2 and P2 (anteroposterior annular diameter) and between the anterolateral commissure and posteromedial commissure (commissure‐to‐commissure annular diameter).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, 3D-TEE analysis was performed off-line using the commercially available semiautomated software package, MVN (Philips Medical Systems, Best, The Netherlands), whose accuracy and reproducibility of 3D quantification have been reported. 15 Briefly, the diameters of the mitral annulus were measured between A2 and P2 (anteroposterior annular diameter) and between the anterolateral commissure and posteromedial commissure (commissure-to-commissure annular diameter). Length and area of the AML (AML length, AML area) were also measured.…”

Section: Echocardiographymentioning

confidence: 99%

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Sakaguchi

Kagiyama

Toki

et al. 2018

JAHA

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BackgroundCarpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation (MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair.Methods and ResultsWe retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P=0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter (P<0.001) and lower left ventricular ejection fraction (P=0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation.ConclusionsAnterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3‐dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy.

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Efficacy and Accuracy of Novel Automated Mitral Valve Quantification: Three‐Dimensional Transesophageal Echocardiographic Study

Abstract: The novel automated software package reduced time for quantification of MV with similar accuracy compared to the manual method. Automated quantification is useful and may be a key to widespread adoption of three-dimensional quantification in clinical practice.

Cited by 33 publications

References 27 publications

The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation

Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

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