Three-dimensional dynamic morphology of the mitral valve in different forms of mitral valve prolapse – potential implications for annuloplasty ring selection

Abstract

BackgroundReal-time three-dimensional transesophageal echocardiography has increased our understanding of the distinct pathomechanisms underlying functional, ischaemic or degenerative mitral regurgitation. However, potential differences in dynamic morphology between the subtypes of degenerative mitral prolapse have scarcely been investigated.MethodsIn order to compare the dynamic behavior of the different phenotypes of degenerative mitral valve prolapse, real-time three-dimensional transesophageal echocardiography recordings of 77 subjects, 27 with Barlow disease (BD), 32 with Fibroelastic deficiency (FED) and 18 normal controls (NC) were analysed.ResultsGeometric annular and valvular parameters of the myxomatous patients were significantly larger compared to controls (BD vs. FED vs. NC 3D annular area: 15 ± 2.8 vs. 13.3 ± 2.4 vs. 10.6 ± 2.3cm2, all p < 0.01). Beside similar ellipticity, BD annuli were significantly flatter compared to FED. Myxomatous annuli appeared less dynamic than normals, with decreased overall 3D area change, however only the BD group differed from NC significantly (BD vs. FED vs. NC normalized 3D area change 4.40 vs. 6.81 vs. 9.69 %; BD vs. NC p = 0.000; FED vs. NC p = not significant, BD vs. FED p = 0.025).ConclusionBD and FED differ not only in terms of valve morphology, but also annular dynamics. Both pathologies are characterized by annular dilatation. However, in BD the annulus is remarkably flattened and hypodynamic, whereas in FED its saddle-shape and contractile function is relatively preserved. These features might influence the choice of repair technique and the selection of annuloplasty ring.

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

“…All patients underwent PAC pre-operatively, and the haemodynamic monitoring was extended for the first 24 hours post-operatively. Seven standard time points of measurements (2,4,6,8,12,16, and 24 hours after surgery) were averaged to calculate mean post-operative values. Central venous pressure (CVP); systolic, diastolic, and mean pulmonary artery pressure (mPAP); pulmonary artery wedge pressure (PAWP); pulmonary vascular resistance (PVR); RV stroke volume index (RVSVi); and cardiac output were monitored.…”

“…However, significant adaptive and maladaptive changes are induced not only in the left ventricular (LV) but also in the right ventricular (RV) morphology and function. 3,4 Functional alterations of the RV are frequent but underrecognized findings in chronic primary MR patients. 5,6 RV function is affected early and through different pathways, including elevated pulmonary pressures, geometrical changes triggered by the altered LV morphology, and the impairment of ventricular interdependence.…”

Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography

“…Inconsistent data on annular measurements in the literature may be related to which anatomic landmarks are assessed. [5][6][7][8][9][10][16][17][18] One example is the distance between the commissures, for which a number of approaches have been reported in the literature: intercommissural width, extended CW, commissure to commissure, maximum transverse diameter, longest diameter, and anterolateralposteromedial diameter. Therefore, estimations of annular area and AHCWR may depend on which anatomic landmarks were included in the measurements.…”

Mitral Valve Prolapse: Current Views and Challenges (Review)

“…Such results were mainly connected with erroneous assumption that a mitral valve has a plane configuration. A series of ultrasound examinations [18,30,31] allowed the physicians to establish that a mitral valve annulus was saddle-shaped, and made the assessment of the valve condition from the parasternal longitudinal position obligatory [32, 33]. Modern medicine defines MVP as a systolic bulging of one or both mitral valve leaflets by no less than 2 mm beyond the mitral annulus plane with its obligatory long-axis registration [5].…”