Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve

Kaplan, Starr R.; Bashein, G.; Sheehan, Florence H.; Legget, Malcolm E.; Munt, Brad; Li, Xiangning; Sivarajan, Murali; Bolson, Edward L.; Zeppa, M.L.; Archa, M.; Martin, Roy W.

doi:10.1016/s0002-8703(00)90077-2

Cited by 170 publications

(121 citation statements)

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“…2,9,10 This improved technology demonstrates a sequence of normal mitral annulus conformational changes over the cardiac cycle. Although atrial contraction may theoretically affect annular shape, no change occurred between early and late diastole.…”

Section: D Dynamics Of the Normal Annulusmentioning

confidence: 99%

“…Nevertheless, the depth of knowledge about mitral annular physiology is limited. Pilot studies performed 3D reconstruction of mitral structure, particularly with MR induced by ischemia 8,9 or cardiomyop-athy. 10 However, the annular geometry and dynamics with MR resulting from myxomatous valve disease (MVD) are uncertain, 11 despite the importance of annuloplasty in surgical treatment.…”

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Mitral Annular Dynamics in Myxomatous Valve Disease

et al. 2010

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Background-Mitral annulus is a complex structure of poorly understood physiology. Full-volume real-time 3-dimensional transesophageal echocardiography offers a unique opportunity to completely image and quantify mitral annulus size and motion. Methods and Results-Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 32 patients with myxomatous valve disease (MVD) and moderate to severe regurgitation, 15 normal control subjects, and 10 patients with ischemic mitral regurgitation of identical body surface area. Mitral annular dimensions (circumference, area, anteroposterior and intercommissural diameters, height, and ratio of height to intercommissural diameter ratio, which appraises annular saddle-shape depth) were measured throughout the cardiac cycle with dedicated quantification software. Compared with direct surgical measurement, 3-dimensional anterior annular dimension provided reliable measurements (mean difference, 0.1Ϯ0.1 mm; Pϭ0.73; 95% confidence interval, Ϯ4.4 mm). Annular dimensions were larger in MVD patients compared with control subjects in diastole (all PϽ0.05). Normal annulus displayed early-systolic anteroposterior (PϽ0.001) and area (Pϭ0.04) contraction, increased height (PϽ0.001), and deeper saddle shape (ratio of height to intercommissural diameter, 15Ϯ1% to 21Ϯ1%; PϽ0.001), whereas intercommissural diameter was unchanged (Pϭ0.30). In contrast, MVD showed early-systolic intercommissural dilatation (Pϭ0.02) and no area contraction (Pϭ0.99), height increase (Pϭ0.11), or saddle-shape deepening (Pϭ0.35). Late-systolic MVD annular saddle shape deepened but annular area excessively enlarged (PϽ0.04) as a result of persistent intercommissural widening (PϽ0.02). MVD annulus also contrasts with ischemic mitral regurgitation annulus, which, despite similar anteroposterior enlargement, is narrower and essentially adynamic. After MVD repair, the annulus remained dynamic without systolic saddle-shape accentuation (Pϭ0.30). Conclusions-Real-time 3-dimensional transesophageal echocardiography provides insights into normal, dynamic mitral annulus function with early-systolic area contraction and saddle-shape deepening contributing to mitral competency. MVD annulus is also dynamic but considerably different with loss of early-systolic area contraction and saddle-shape deepening despite similar magnitude of ventricular contraction, suggestive of ventricular-annular decoupling. Subsequent area enlargement may contribute to mitral incompetence. After mitral repair, MVD annulus remains dynamic without systolic saddle-shape accentuation. Thus, real-time 3-dimensional transesophageal echocardiography provides new insights that allow the refining of mitral pathophysiology concepts and repair strategies. (Circulation.

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Section: D Dynamics Of the Normal Annulusmentioning

confidence: 99%

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confidence: 99%

Mitral Annular Dynamics in Myxomatous Valve Disease

et al. 2010

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“…Many studies report that mitral apparatus changes may contribute to ischemic mitral regurgitation (MR); however the main mechanism is still under controversy [1][2][3][4][5]. An optimal surgical approach to ischemic MR has not been reached yet as the exact MR mechanism remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Observation of Mitral Apparatus Change in Acute Ischemic Mitral Regurgitation by Live Three-Dimensional Echocardiography

et al. 2006

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Objective. Mitral apparatus geometry changes during ischemic mitral regurgitation (MR) play an important role in finding mechanisms for ischemic MR. Live three-dimensional echocardiography (L3DE) is a new technique providing cardiac full-volume image in a very short time. We applied this technique to evaluate mitral apparatus geometry changes during acute ischemic MRs.Methods. After baseline two-dimensional echocardiography (2DE) and L3DE image acquiring, the left circumflex (LCX) coronary artery distal to the first obtuse marginal artery origin was ligated in order to produce an acute ischemic MR in 10 canines. When significant ischemic MR occurred, 2DE and L3DE imagings were repeated. PM tethering distance and mitral annular geometric dilation were measured by L3DE.

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“…Estas implicaciones son las que se tienen en cuenta actualmente para el diseño y selección de prótesis mitral anular (Kaplan et al 2000), así que la variación fundamental se hizo en la forma y se conservaron las dimensiones básicas. En el modelo este ajuste nos llevó a una longitud de cuerda de 8.7 cm, valor que está en el rango experimental, ya que de acuerdo a información reportada por Ormiston et al (1981) los valores de cuerda en la válvula mitral fluctúan entre 7.0 y 10.5.…”

Section: El Modelo Anatómico De Aurícula Normalunclassified

Estudio de la vulnerabilidad a reentradas a través de modelos matemáticos y simulación de la aurícula humana

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Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve

Cited by 170 publications

References 19 publications

Mitral Annular Dynamics in Myxomatous Valve Disease

Mitral Annular Dynamics in Myxomatous Valve Disease

Observation of Mitral Apparatus Change in Acute Ischemic Mitral Regurgitation by Live Three-Dimensional Echocardiography

Estudio de la vulnerabilidad a reentradas a través de modelos matemáticos y simulación de la aurícula humana

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