The Relationship Between the Mitral Annulus and Left Ventricular Outflow Tract

Komoda, Takeshi; Hetzer, Roland; Oellinger, Johann; Siniawski, Henryk; Hofmeister, J.; Hübler, Michael; Félix, R.; Uyama, Chikao; Maeta, Hajime

doi:10.1097/00002480-199711000-00016

Cited by 10 publications

(3 citation statements)

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“…The anterior anulus is normally flexed atrially and away from the LVOT. Similar to what other investigators found, [17][18][19][20] we found that this flexion angle increases during systolic contraction, when the posterior anulus moves toward the LVOT, to maintain the anterior anulus away from the LVOT during ejection. The semirigid Physio ring flattened the anulus and positioned the anterior anulus into the LVOT.…”

Section: Discussionsupporting

confidence: 91%

Potential mechanism of left ventricular outflow tract obstruction after mitral ring annuloplasty

Dagum

Green²,

Glasson³

et al. 1999

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 91%

Potential mechanism of left ventricular outflow tract obstruction after mitral ring annuloplasty

Dagum

Green²,

Glasson³

et al. 1999

The Journal of Thoracic and Cardiovascular Surgery

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“…2,[12][13][14] The change of angle between the mitral annulus and the LV outfl ow tract during the cardiac cycle in humans was described by Komoda and colleagues. 15 Timek and colleagues 16 recently reported that the aortomitral angle changed by 7° ± 2° during the cardiac cycle, increasing signifi cantly during inotropic stimulation. The aortomitral angle excursion was slightly larger in our experimental setting.…”

Section: Discussionmentioning

confidence: 99%

Kinking of the Atrioventricular Plane during the Cardiac Cycle

Goetz

Lansac

Lim

et al. 2006

Asian Cardiovasc Thorac Ann

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Systolic descent of the atrioventricular plane toward the relatively stationary left ventricular apex is well described. As the atrioventricular plane includes two separate valvular units, systolic atrioventricular plane displacement should not be homogenous. In 6 sheep, sonomicrometric crystals were implanted at the base of the right coronary sinus, anterolateral and posteromedial fibrous trigones, posterior mitral annulus, left ventricular apex, and the tips of the anterior and posterior mitral leaflets. The aortomitral angle was calculated and related to simultaneous left ventricular and aortic pressures and mitral valve movement. The aortomitral angle was largest at end diastole (150.73 degrees +/- 15.48 degrees ). During isovolumic contraction, it narrowed rapidly to 144.90 degrees +/- 16.64 degrees , followed by a slower narrowing during ejection until it reached its smallest angle at end systole (139.66 degrees +/- 16.78 degrees ). During isovolumic relaxation, the aortomitral angle increased to 143.66 degrees +/- 16.02 degrees at the beginning of diastole. During the first third of diastole, it narrowed again to 141 degrees +/- 16.24 degrees before re-expanding to maximum at end diastole. During systole, the atrioventricular plane descended non-homogeneously toward the apex, with kinking at the hinge between the aortic and mitral annulus plane. This deformation of the atrioventricular plane has relevance in valve surgery.

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“…The mitral orifice is a dynamic structure with a complex dynamic interaction between the annulus and the LV outflow tract. 14 The intertrigonal distance normally expands during diastole, facilitating ventricular filling, and contracts during systole, thereby improving leaflet coaptation. 15,16 Thus, an ideal annuloplasty device should provide long-term stability of the reconstructive procedure by reducing stress and strain on the leaflets and the chordal structures, and provide a low transvalvular gradient and still preserve all components of a physiologic MV function (eg, restore the anterior-posterior ratio, reduce the posterior ring diameter, maintain the 3-dimensional saddle shape, and allow for a dynamic change in annular diameters during the cardiac cycle).…”

Section: Discussionmentioning

confidence: 99%