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Oliveira D, Srinivasan J, Espino D, Buchan K, Dawson D, Shepherd D. Geometric description for the anatomy of the mitral valve: A review. J Anat 2020; 237:209-224. [PMID: 32242929 DOI: 10.1111/joa.13196] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
The mitral valve is a complex anatomical structure whose physiological functioning relies on the biomechanical properties and structural integrity of its components. Their compromise can lead to mitral valve dysfunction, associated with morbidity and mortality. Therefore, a review on the morphometry of the mitral valve is crucial, more specifically on the importance of valve dimensions and shape for its function. This review initially provides a brief background on the anatomy and physiology of the mitral valve, followed by an analysis of the morphological information available. A characterisation of mathematical descriptions of several parts of the valve is performed and the impact of different dimensions and shape changes in disease is then outlined. Finally, a section regarding future directions and recommendations for the use of morphometric information in clinical analysis of the mitral valve is presented.
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Affiliation(s)
- Diana Oliveira
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | | | - Daniel Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Keith Buchan
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Dana Dawson
- Cardiology Research Facility, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK
| | - Duncan Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
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Kreidel F, Ruf T, Tamm A, Geyer M, Emrich T, von Bardeleben RS. [Evaluation of mitral regurgitation : How much quantification do we need?]. Herz 2019; 44:574-585. [PMID: 31555893 DOI: 10.1007/s00059-019-04857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Severe mitral regurgitation (MR) is associated with increased morbidity and mortality. Thus, the correct evaluation of the underlying etiology, pathomechanism and severity is crucial for optimal treatment. Echocardiography is the predominant diagnostic modality in the clinical routine as it enables grading of mitral regurgitation, which can frequently be achieved by readily available qualitative parameters. Additionally, echocardiography provides several methods to quantify the hemodynamic significance of MR. The effective regurgitation orifice area (EROA) is the quantitative parameter best correlated with clinical events. American and European imaging guidelines both recommend the use of quantitative parameters even though they disagree on the cut-off values for secondary MR. The evaluation of MR should always include an assessment of the adjacent heart chambers in order to be able to assess the impact of volume overload on size and function of the left ventricle and left atrium. The final interpretation of the quantitative parameters requires knowledge of left ventricular volume and ejection fraction. Newer 3D-echocardiographic approaches to quantify MR are less dependent on mathematical assumptions and have shown convincing results in several studies but still lack sufficient clinical validation. As an alternative to echocardiography, for specific indications cardiac magnetic resonance imaging (MRI) has proven to be a systematic and observer-independent method for quantification of MR.
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Affiliation(s)
- F Kreidel
- Department of Cardiology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - T Ruf
- Department of Cardiology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - A Tamm
- Department of Cardiology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - M Geyer
- Department of Cardiology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - T Emrich
- Klinik für Radiologie der Universitätsmedizin Main, Mainz, Deutschland
| | - R S von Bardeleben
- Department of Cardiology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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Li Y, Zhang H, Zhang H, Luo T, Wang J, Zhu Z, Han J, Li Y, Meng X. Structural analysis of the mitral valve in rheumatic and degenerative mitral valve diseases: implications for annuloplasty selection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:617-623. [PMID: 31274274 DOI: 10.23736/s0021-9509.19.10814-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mitral valve (MV) repair has been recommended for MV diseases. Good repair requires a full understanding of the three-dimensional (3D) structure of the MV, however, currently little is known about the 3D structure of the rheumatic MV. METHODS A total of 82 cases underwent 3DTEE. Of these, 41 patients with rheumatic valvular disease (RVD) were studied intraoperatively (17 had severe mitral stenosis, 8 had severe mitral regurgitation, 16 had severe mitral stenosis coupled with regurgitation). There were 19 patients with degenerative MV disease (mitral valve prolapse [MVP] with severe regurgitation) and 22 cases with normal MV served as control subjects (CS). RESULTS Compared with CS, the anteroposterior diameter, anterolateral posteromedial, annulus circumference, and annulus area of both pathological groups, i.e., the RVD and MVP groups, were understandably greater. Though the sphericity index was greater in the RVD group vis-à-vis CS, the MVP group had nearly the same sphericity index as CS. The mitral annulus of patients with RVD tended to be round. Annular unsaddling, defined as annular height to commissural width ratio (an indicator of saddle degree) less than 15%, was significantly more prevalent in the group with degenerative MV disease. Automatic dynamic analysis revealed that the parameters of annular maximum displacement and annulus area fraction (two-dimensional) were considerably decreased in the RVD group. CONCLUSIONS Annular unsaddling was significantly more prevalent in the degenerative MV disease group. The mitral annulus of patients with RVD tended to be round and stiff.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Han Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tiange Luo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhihui Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China -
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Noack T, Janietz M, Lurz P, Kiefer P, Sieg F, Marin-Cuartas M, Spampinato R, Besler C, Rommel KP, Holzhey D, Mohr FW, Ender J, Borger MA, Seeburger J. Dynamic mitral valve geometry in patients with primary and secondary mitral regurgitation: implications for mitral valve repair†. Eur J Cardiothorac Surg 2019; 56:983-992. [DOI: 10.1093/ejcts/ezz096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 01/02/2023] Open
Abstract
Abstract
OBJECTIVES
The goal of this study was to quantify the mitral valve (MV) annulus, the MV shape and the anatomical MV orifice area throughout the cardiac cycle using 4-dimensional MV analysis software in patients with primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) in comparison to a healthy control group.
METHODS
Three-dimensional transoesophageal echocardiograms of the MV were acquired for 29 patients with PMR, for 28 patients with SMR and for 18 healthy control subjects. The MV was quantified with regards to anterior-posterior and lateromedial diameter, annular area and circumference, intertrigonal (IT) distance, annular sphericity index, annular height to commissural width ration, and anatomical MV orifice area throughout the cardiac cycle using 3-dimensional transoesophageal echocardiography-based 4-dimensional MV advanced analysis software.
RESULTS
Normal annulus dynamics display a systolic enlargement followed by an early-diastolic plateau phase and a late-diastolic contraction. The IT distance showed a linear association with the anterior-posterior diameter (= 1.11 × IT distance) and lateromedial diameter (= 1.44 × IT distance) in the control subjects. Mitral regurgitation is associated with a less dynamic, planar and dilated annulus with small variations between PMR and SMR. The IT distance was less affected by mitral regurgitation compared to the control subjects.
CONCLUSIONS
The novel 4-dimensional MV analysis allows new insights into the dynamic MV geometry in patients with PMR and SMR compared to the control subjects. The IT distance may be used to predict annuloplasty ring sizing.
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Affiliation(s)
- Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Marie Janietz
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Philipp Lurz
- University Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Franz Sieg
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Ricardo Spampinato
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Christian Besler
- University Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- University Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - David Holzhey
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Joerg Ender
- Department of Anaesthesiology, Heart Center Leipzig, Leipzig, Germany
| | | | - Joerg Seeburger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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Patzelt J, Zhang Y, Magunia H, Ulrich M, Jorbenadze R, Droppa M, Zhang W, Lausberg H, Walker T, Rosenberger P, Seizer P, Gawaz M, Langer HF. Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system. Eur Heart J Cardiovasc Imaging 2019; 19:785-791. [PMID: 28977372 DOI: 10.1093/ehjci/jex173] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Improved mitral valve leaflet coaptation with consecutive reduction of mitral regurgitation (MR) is a central goal of percutaneous mitral valve repair (PMVR) with the MitraClip® system. As influences of PMVR on mitral valve geometry have been suggested before, we examined the effect of the procedure on mitral annular size in relation to procedural outcome. Methods and results Geometry of the mitral valve annulus was evaluated in 183 patients undergoing PMVR using echocardiography before and after the procedure and at follow-up. Mitral valve annular anterior-posterior (ap) diameter decreased from 34.0 ± 4.3 to 31.3 ± 4.9 mm (P < 0.001), and medio-lateral (ml) diameter from 33.2 ± 4.8 to 32.4 ± 4.9 mm (P < 0.001). Accordingly, we observed an increase in MV leaflet coaptation after PMVR. The reduction of mitral valve ap diameter showed a significant inverse correlation with residual MR. Importantly, the reduction of mitral valve ap diameter persisted at follow-up (31.3 ± 4.9 mm post PMVR, 28.4 ± 5.3 mm at follow-up). Conclusion This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.
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Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Yingying Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Wenzhong Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Henning Lausberg
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
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Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation. J Am Soc Echocardiogr 2019; 32:655-666.e13. [PMID: 30826226 DOI: 10.1016/j.echo.2019.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function. METHODS Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured. RESULTS Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area)0.5 increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10° decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P ≤ .01 for all). CONCLUSIONS The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.
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Tang Z, Fan YT, Wang Y, Jin CN, Kwok KW, Lee APW. Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2019; 32:503-513. [PMID: 30679142 DOI: 10.1016/j.echo.2018.11.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS In patients with AF and absent LA contraction, the normal predominantly "atriogenic" annular dynamics become "ventriculogenic." Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. "Atrial" functional MR may not be purely an atrial disorder.
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Affiliation(s)
- Zhe Tang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yi-Ting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Wang
- Cardiology Department, Chinese PLA General Hospital, Beijing, China
| | - Chun-Na Jin
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Park J, Geirsson A, Bonde PN. Mathematical Blueprint of a Mitral Valve. Semin Thorac Cardiovasc Surg 2019; 31:399-411. [DOI: 10.1053/j.semtcvs.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 01/01/2023]
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Hei S, Iwataki M, Jang JY, Kuwaki H, Mahara K, Fukuda S, Kim YJ, Nabeshima Y, Onoue T, Nagata Y, Nishino S, Watanabe N, Takeuchi M, Nishimura Y, Song JK, Levine RA, Otsuji Y. Possible mechanism of late systolic mitral valve prolapse: systolic superior shift of leaflets secondary to annular dilatation that causes papillary muscle traction. Am J Physiol Heart Circ Physiol 2018; 316:H629-H638. [PMID: 30575434 DOI: 10.1152/ajpheart.00618.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Progressive superior shift of the mitral valve (MV) during systole is associated with abnormal papillary muscle (PM) superior shift in late systolic MV prolapse (MVP). The causal relation of these superior shifts remains unclarified. We hypothesized that the MV superior shift is related to augmented MV superiorly pushing force by systolic left ventricular pressure due to MV annular dilatation, which can be corrected by surgical MV plasty, leading to postoperative disappearance of these superior shifts. In 35 controls, 28 patients with holosystolic MVP, and 28 patients with late systolic MVP, the MV coaptation depth from the MV annulus was measured at early and late systole by two-dimensional echocardiography. The PM tip superior shift was monitored by echocardiographic speckle tracking. MV superiorly pushing force was obtained as MV annular area × (systolic blood pressure - 10). Measurements were repeated after MV plasty in 14 patients with late systolic MVP. Compared with controls and patients with holosystolic MVP, MV and PM superior shifts and MV superiorly pushing force were greater in patients with late systolic MVP [1.3 (0.5) vs. 0.9 (0.6) vs. 3.9 (1.0) mm/m2, 1.3 (0.5) vs. 1.2 (1.0) vs. 3.3 (1.3) mm/m2, and 487 (90) vs. 606 (167) vs. 742 (177) mmHg·cm2·m-2, respectively, means (SD), P < 0.001]. MV superior shift was correlated with PM superior shift ( P < 0.001), which was further related to augmented MV superiorly pushing force ( P < 0.001). MV and PM superior shift disappeared after surgical MV plasty for late systolic MVP. These data suggest that MV annulus dilatation augmenting MV superiorly pushing force may promote secondary superior shift of the MV (equal to late systolic MVP) that causes subvalvular PM traction in patients with late systolic MVP. NEW & NOTEWORTHY Late systolic mitral valve prolapse (MVP) is associated with mitral valve (MV) and papillary muscle (PM) abnormal superior shifts during systole, but the causal relation remains unclarified. MV and PM superior shifts were correlated with augmented MV superiorly pushing force by annular dilatation and disappeared after surgical MV plasty with annulus size and MV superiorly pushing force reduction. This suggests that MV annulus dilatation may promote secondary superior shifts of the MV (late systolic MVP) that cause subvalvular PM traction.
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Affiliation(s)
- Soshi Hei
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Jeong-Yoon Jang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Hiroshi Kuwaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute , Tokyo , Japan
| | - Shota Fukuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yun-Jeong Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center , Miyazaki , Japan
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center , Miyazaki , Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
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Bouchez S, Mackensen GB, Mauermann E, McCleish L, Cobey F, Swaminathan M, Wouters P. Differences in Two- and Three-Dimensional Assessment of the Mitral Valve by Novices and Experts, Illustrated Using Anterior Mitral Valve Leaflet Length. J Cardiothorac Vasc Anesth 2018; 33:1022-1028. [PMID: 30448072 DOI: 10.1053/j.jvca.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In this measurement validation study, the authors evaluated agreement between 2-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE), measuring anterior mitral valve leaflet length by both novice and experienced echocardiographers. DESIGN This was a retrospective, observational study. SETTING Single university hospital. PARTICIPANTS Analyses on datasets from 44 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Fifty datasets from 44 patients with mitral regurgitation were analyzed by 4 observers (2 novices, 2 experts). All observers measured the anterior mitral valve leaflet length from end-systolic 2D TEE images from the midesophageal longitudinal axis view and 3D software-augmented TEE images. The overall mean anterior mitral valve leaflet length was significantly shorter with 3D versus 2D TEE measurements (24.6 ± 4.5 mm v 26.2 ± 5.3 mm; p < 0.001), with novices measuring shorter leaflets than experts for both techniques (p < 0.001 and p = 0.005, respectively). Bland-Altman plots of 3D and 2D TEE measurements showed mean biases (95% limits of agreement) of -1.6 mm (-9.0 to 5.9 mm), -1.8 mm (-9.6 to 6.0 mm), and -1.3 mm (-8.4 to 5.7 mm) for all observers, novices, and experts, respectively. For 2D measurements, interobserver reliability was very strong among experts and strong among novices (Pearson's r = 0.83 v 0.66; p = 0.055). For 3D measurements, interobserver reliability was strong in experts and moderate in novices (Pearson's r = 0.69 v 0.51; p = 0.168). CONCLUSION For both novices and experts, 3D TEE measurements of the anterior mitral valve leaflet were significantly shorter than 2D measurements. Interobserver reliability was lowest for novices making 3D TEE measurements, indicating that reliable, quantitative evaluation of 3D TEE may require a greater amount of practice.
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Affiliation(s)
- Stefaan Bouchez
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Eckhard Mauermann
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium; Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Basel, Switzerland
| | - Linda McCleish
- Department of Anesthesiology, Sentara Heart Hospital, Norfolk, VA
| | - Frederick Cobey
- Department of Anesthesiology and Preoperative Medicine, Tufts Medical Center, Boston, MA
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Patrick Wouters
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
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Alkhouly AA, Al-Amin AM, Mukarrab MI. Role of three dimensional transesophageal echocardiography in predicting mitral regurgitation after percutaneous balloon mitral valvuloplasty. Indian Heart J 2018; 70:836-842. [PMID: 30580853 PMCID: PMC6306348 DOI: 10.1016/j.ihj.2018.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/27/2017] [Accepted: 01/20/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Percutaneous balloon mitral valvuloplasty (PBMV) can be complicated with significant mitral regurgitation (MR). We performed a pilot, prospective study to evaluate the role of three dimensional transesophageal echocardiography (3D-TEE) in the prediction of MR after PBMV through mitral valve quantification (MVQ). METHODS Between October 2014 and October 2016, 37 patients with rheumatic, moderate-to-severe mitral stenosis, referred to the Cath lab of Bab Alshearia University hospitals for PBMV, were divided into two age and sex matched groups. Group I included 25 patients without significant MR following PBMV [vena contract area (VCA) <0.4cm2], while group II included 12 patients with significant MR after PBMV [VCA ≥0.4cm2]. Both groups were comparable in terms of TEE data, Wilkins score for favorability of PBMV and baseline hemodynamics. RESULTS Data from MVQ showed that both groups were comparable (p>0.05) in terms of MV annulus quantification (Anteroposterior diameter, annular sphericity, 3D area and height), MV scallops (A1, A2, A3, P1, P2 and P3) areas, as well as A1 and A2 tenting volumes. However, we recorded significant differences between the two groups as regard total MV, A2, P2 and P3 tenting volumes (p<0.05) and tenting height (p=0.03), as well as A2, A3 and P2 prolapse volumes (p<0.05). Moreover, our data showed a significant difference between both groups in terms of MV coaptation heights (p=0.01), but not in anterior coaptation length (p=0.13). CONCLUSION Mitral valve quantification through 3D-TEE is a simple automated method, easily applicable to patients before PBMV. Moreover, MVQ-derived data, such as MV scallops' tenting and prolapse volumes, coaptation heights, and exposed and total A2 lengths may predict the possibility of significant MR after PBMV.
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Affiliation(s)
| | - Ali Mohammad Al-Amin
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Three-Dimensional Echocardiographic Assessment of Mitral Annular Physiology in Patients With Degenerative Mitral Valve Regurgitation Undergoing Surgical Repair: Comparison between Early- and Late-Stage Severe Mitral Regurgitation. J Am Soc Echocardiogr 2018; 31:1178-1189. [DOI: 10.1016/j.echo.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/19/2022]
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Noack T, Kiefer P, Mallon L, Lurz P, Bevilacqua C, Banusch J, Emrich F, Holzhey DM, Vannan M, Thiele H, Mohr FW, Borger MA, Ender J, Seeburger J. Changes in dynamic mitral valve geometry during percutaneous edge-edge mitral valve repair with the MitraClip system. J Echocardiogr 2018; 17:84-94. [PMID: 30291509 DOI: 10.1007/s12574-018-0398-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to quantify the acute dynamic changes of mitral valve (MV) geometry throughout the cardiac cycle-during percutaneous MV repair with the MitraClip system by 3-dimensional transesophageal echocardiography (3D TEE). METHODS The MV was imaged throughout the cardiac cycle (CC) before and after the MitraClip procedure using 3D TEE in 28 patients (mean age, 77 ± 8 years) with functional mitral regurgitation (FMR). Dynamic changes in the MV annulus geometry and anatomical MV orifice area (AMVOA) were quantified using a novel semi-automated software. RESULTS Percutaneous MV repair decreased anterior-posterior diameter by up to 9% (at 50% of CC; from 34.5 to 31.9 mm; p < 0.001) throughout the CC and increased the diastolic lateral-medial diameter by up to 7% (at 60% of the CC; from 39.7 to 42.3 mm; p < 0.001), whereas the annular circumference and area were not significantly affected. Annulus sphericity index was reduced up to 13% (at 50% of the CC; from 0.89 to 0.78, p < 0.001). The AMVOA also decreased during systole, the maximum decrease being from 0.6 to 0.2 mm2 (at 0% of CC; p = 0.007), and during diastole the maximum decrease being from 4.6 to 1.6 cm2 (at 50% of CC; p < 0.001). CONCLUSIONS Percutaneous MV repair reduces the MR by an improved coaptation of MV leaflets joint with a simultaneous indirect reduction of anterior-posterior diameter. Further, the MitraClip procedure leads to a reduction of AMVOA of more than 60% during diastole.
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Affiliation(s)
- Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany.
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Linda Mallon
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig University, Leipzig, Germany
| | - Carmine Bevilacqua
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Joergen Banusch
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Fabian Emrich
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - David M Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Mani Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig University, Leipzig, Germany
| | | | - Michael Andrew Borger
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Joerg Ender
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Joerg Seeburger
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
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Mantegazza V, Pasquini A, Agati L, Fusini L, Muratori M, Gripari P, Ghulam Ali S, Vignati C, Bartorelli AL, Ferrari C, Alamanni F, Pepi M, Tamborini G. Comprehensive Assessment of Mitral Valve Geometry and Cardiac Remodeling With 3-Dimensional Echocardiography After Percutaneous Mitral Valve Repair. Am J Cardiol 2018; 122:1195-1203. [PMID: 30082038 DOI: 10.1016/j.amjcard.2018.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/01/2023]
Abstract
MitraClip is a validated treatment for significant mitral regurgitation (MR) in high-risk patients. Aims of the study were to evaluate immediate changes in mitral valve (MV) geometry induced by MitraClip and correlations between baseline geometry and cardiac remodeling. Eighty patients who underwent MitraClip for primary (48%) or secondary (52%) MR were enrolled. Intraoperative transesophageal echocardiographic 3D images were acquired immediately before and after the procedure for MV annulus (MVA) morphology analysis. Transthoracic 3D echocardiography was performed preoperatively and at 6 months follow-up (6MFU). Patients were classified on the basis of MR reduction (ΔMR) at 6MFU as Optimal (ΔMR ≥ 2) or Suboptimal (ΔMR < 2). An optimal result was reached in 60 (75%) patients, whereas 20 subjects showed a ΔMR< 2 at 6MFU. The Optimal showed significantly smaller baseline MVA (antero-posterior diameter 4.05 ± 0.59 vs 4.43 ± 0.68 cm; anterolateral-posteromedial diameter 4.38 ± 0.56 vs 4.70 ± 0.73 cm; MVA circumference 14.1 ± 1.7 vs 15.1 ± 2.3 cm; and 3D area 14.8 ± 3.9 vs 17.4 ± 5.3 cm2), lower sphericity index and nonplanar angle compared with Suboptimal. A value of antero-posterior diameter ≥4.44cm was identified (receiver-operating characteristic curve) as a possible cut-off for preoperative identification of Suboptimal patients. Postoperatively, MitraClip induced reduction of MVA flattening (nonplanar angle), sphericity index, and size (as expressed by antero-posterior diameter, MVA circumference and area). At 6MFU, the Optimal showed significant decrease in left ventricular volumes and pulmonary artery systolic pressure. In conclusion, MitraClip induces remarkable changes in MVA geometry and favorable left ventricular remodeling is detected in patients with optimal mid-term outcome; a preprocedural antero-posterior diameter <4.44cm seems to be a potential predictor of mid-term optimal result.
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Menciotti G, Borgarelli M, Aherne M, Camacho P, Häggström J, Ljungvall I, Lahmers SM, Abbott JA. Comparison of the mitral valve morphologies of Cavalier King Charles Spaniels and dogs of other breeds using 3D transthoracic echocardiography. J Vet Intern Med 2018; 32:1564-1569. [PMID: 30238697 PMCID: PMC6189382 DOI: 10.1111/jvim.15252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/25/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background Myxomatous mitral valve disease (MMVD) is more prevalent in Cavalier King Charles Spaniels (CKCSs) compared to dogs of other breeds at a given age. Abnormal valvular stress is thought to contribute to the development and progression of MMVD, and a relationship exists between mitral valve (MV) morphology and stress acting on the valve. Objectives To determine whether the MV morphology of healthy adult CKCSs differs from the morphology of healthy adult dogs of other breeds determined by RT‐3DTTE. Animals Thirty‐five healthy CKCSs and 41 healthy dogs of other breeds. Methods Prospective cross‐sectional study. Dogs underwent physical examination, conventional echocardiography, and RT‐3DTTE. RT–3DTTE datasets were analyzed using dedicated software for MV morphologic analysis. Morphologic variables were compared between CKCSs and dogs of other breeds. Results The MV of healthy CKCSs had a smaller annulus height (0.46 ± 0.11 vs. 0.56 ± 0.17; P = .0021), tenting height (0.26 ± 0.12 vs. 0.42 ± 0.18; P < .001), tenting area (0.42 ± 0.15 vs. 0.79 ± 0.34; P < .001), normalized tenting volume (0.09 [0.05–0.13] vs. 0.14 [0.10–0.20]; P < .001), and normalized area of the posterior leaflet (0.57 ± 0.15 vs. 0.66 ± 0.18; P = .016) compared to healthy dogs of other breeds; this results in CKCSs having a flatter MV with reduced tenting, compared to the MV of other breeds. Conclusions and Clinical Importance These morphologic features could confer a mechanical disadvantage and play a role in the predisposition of CKCSs to the early development of MMVD.
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Affiliation(s)
- Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Michael Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Paula Camacho
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Sunshine M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Jonathan A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
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Cong T, Gu J, Lee APW, Shang Z, Sun Y, Sun Q, Wei H, Chen N, Sun S, Fu T. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound 2018; 16:13. [PMID: 30126422 PMCID: PMC6102822 DOI: 10.1186/s12947-018-0131-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Atrial fibrillation (AF) can result in atrial functional mitral regurgitation (MR), but the mechanism remains controversial. Few data about the relationship between the 3-dimensional morphology of the MV and the degree of MR in AF exist. Methods Real-time 3-dimensional transesophageal echocardiography (3D-TEE) of the MV was acquired in 168 patients with AF (57.7% persistent AF), including 25 (14.9%) patients with moderate to severe MR (the MR+ group) and 25 patients without AF as controls. The 3-dimensional geometry of the MV apparatus was acquired using dedicated quantification software. Results Compared with the group of patients with no or mild MR (the MR- group) and the controls, the MR+ group had a larger left atrium (LA), a more dilated mitral annulus (MA), a reduced annular height to commissural width ratio (AHCWR), indicating flattening of the annular saddle shape, and greater leaflet surfaces and tethering. MR severity was correlated with the MA area (r2 = 0.43, P < 0.01) and the annulus circumference (r2 = 0.38, P < 0.01). A logistic regression analysis indicated that the MA area (OR: 1.02, 95% CI: 1.01–1.03, P < 0.01), AHCWR (OR: 0.24, 95% CI: 0.14–0.35, P = 0.04) and MV tenting volume (OR: 3.24, 95% CI: 1.16–9.08, P = 0.03) were independent predictors of MR severity in AF patients. Conclusions The mechanisms of “atrial functional MR” are complex and include dilation of the MA, flattening of the annular saddle shape and greater leaflet tethering.
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Affiliation(s)
- Tao Cong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China.
| | - Jinping Gu
- Department of Intensive Care Unit, The Second Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Prince of Wales Hospital of Chinese University of Hong Kong, Hong Kong, China
| | - Zhijuan Shang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Yinghui Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Qiaobing Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Hong Wei
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Na Chen
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Siyao Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
| | - Tingting Fu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116000, Liaoning, China
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Karvandi M. Advanced Technologies in the Quantification of Mitral Valve. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Jolley MA, Hammer PE, Ghelani SJ, Adar A, Sleeper LA, Lacro RV, Marx GR, Nathan M, Harrild DM. Three-Dimensional Mitral Valve Morphology in Children and Young Adults With Marfan Syndrome. J Am Soc Echocardiogr 2018; 31:1168-1177.e1. [PMID: 30098871 DOI: 10.1016/j.echo.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mitral valve (MV) prolapse is common in children with Marfan syndrome (MFS) and is associated with varying degrees of mitral regurgitation (MR). However, the three-dimensional (3D) morphology of the MV in children with MFS and its relation to the degree of MR are not known. The goals of this study were to describe the 3D morphology of the MV in children with MFS and to compare it to that in normal children. METHODS Three-dimensional transthoracic echocardiography was performed in 27 patients (3-21 years of age) meeting the revised Ghent criteria for MFS and 27 normal children matched by age (±1 year). The 3D geometry of the MV apparatus in midsystole was measured, and its association with clinical and two-dimensional echocardiographic parameters was examined. RESULTS Compared with age-matched control subjects, children with MFS had larger 3D annular areas (P < .02), smaller annular height/commissural width ratios (P < .001), greater billow volumes (P < .001), and smaller tenting heights, areas, and volumes (P < .001 for all). In multivariate modeling, larger leaflet billow volume in MFS was strongly associated with moderate or greater MR (P < .01). Intra- and interuser variability of 3D metrics was acceptable. CONCLUSIONS Children with MFS have flatter and more dilated MV annuli, greater billow volumes, and smaller tenting heights compared with normal control subjects. Larger billow volume is associated with MR. Three-dimensional MV quantification may contribute to the identification of patients with MFS and other connective tissue disorders. Further study of 3D MV geometry and its relation to the clinical progression of MV disease is warranted in this vulnerable population.
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Affiliation(s)
- Matthew A Jolley
- Department of Anesthesia and Critical Care Medicine and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
| | - Peter E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Adi Adar
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ronald V Lacro
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse. J Am Coll Cardiol 2018; 72:823-834. [DOI: 10.1016/j.jacc.2018.06.048] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 11/20/2022]
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Huang DQ, Cui CY, Zhang J, Liu YY, Qin YY, Zhang LZ, Liu L. Effects of nonvalvular atrial fibrillation on the structure and function of mitral valves (a STROBE-compliant article). Medicine (Baltimore) 2018; 97:e11643. [PMID: 30113455 PMCID: PMC6112909 DOI: 10.1097/md.0000000000011643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to explore the effects of nonvalvular atrial fibrillation (NVAF) on the structure and function of mitral valve and analyze independent risk factors of moderate to severe mitral regurgitation (MR) by quantitative measurement of mitral parameters using real-time 3-dimensional transesophageal echocardiography.This study included 30 subjects with sinus rhythm group, and 65 patients with NVAF. The 65 patients with NVAF were divided into 35 with paroxysmal atrial fibrillation group and 30 with persistent atrial fibrillation. According to MR degree, the patients with NVAF were again divided into no or mild MR group (n = 44) and moderate to severe MR group (n = 21).There were significant differences in anterolateral-to-posteromedial diameter (DAlPm), anterior-to-posterior diameter, 3-dimensional circumference (C3D), 2-dimensional area (A2D), mitral leaflet surface area in late systolic phase, the index of mitral valve coaptation and left atrial internal diameter (LAID) between different cardiac rhythm groups (all P < .05). The DAlPm, C3D, A2D, nonplanar angle (θNPA), and LAID were greater but the mitral valve coaptation index was smaller in the moderate to severe MR group than in the no or mild MR group (all P < .05). Logistic regression analysis indicated that DAlPm and LAID were independent risk factors of moderate to severe MR in the patients with NVAF (OR > 1, P < .05).DAlPm and LAID are independent risk factors of moderate to severe MR in the patients with NVAF. NVAF can change the structure and function of mitral valve, which leads to MR.
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Mooney J, Sellers SL, Ohana M, Cavalcante JL, Arepalli CD, Grover R, Kim U, Selvakumar K, Blanke P, Leipsic JA. Imaging for structural heart procedures: focus on computed tomography. EUROINTERVENTION 2018; 13:AA85-AA96. [PMID: 28942390 DOI: 10.4244/eij-d-17-00516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The success and continued rapid clinical integration of transcatheter valve technologies relies on imaging modalities to guide safe and effective device deployment. In particular, cardiac imaging, using both echocardiography and CT, is an integral resource for the multidisciplinary team. These modalities can provide valuable insight for the proceduralist at each stage of transcatheter-based valve insertion, as they can be used reliably to define the anatomy of interest and its relationship to surrounding structures, determine accurate device sizing, assess patients for valve-in-valve procedures, and screen for adverse features or procedural contraindications. We provide an overview of some of the key aspects of the use of CT and echocardiography in the context of transcatheter aortic valve replacement (TAVR), as well as transcatheter mitral valve replacement (TMVR).
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Affiliation(s)
- John Mooney
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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Pardi MM, Pomerantzeff PMA, Sampaio RO, Abduch MC, Brandão CMA, Mathias W, Grinberg M, Tarasoutchi F, Vieira MLC. Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study. Echocardiography 2018; 35:1342-1350. [PMID: 29920772 DOI: 10.1111/echo.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. METHODS Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. RESULTS There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P = .038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P < .05). CONCLUSION Three-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MR ≥ grade II, what could suggest a potential benefit of early surgical treatment.
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Affiliation(s)
- Mirian M Pardi
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Maria C Abduch
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos M A Brandão
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Mathias
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Max Grinberg
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Flavio Tarasoutchi
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcelo L C Vieira
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Fernández-Friera L, Salguero R, Vannini L, Argüelles AF, Arribas F, Solís J. Mechanistic insights of the left ventricle structure and fibrosis in the arrhythmogenic mitral valve prolapse. Glob Cardiol Sci Pract 2018; 2018:4. [PMID: 29644231 PMCID: PMC5857061 DOI: 10.21542/gcsp.2018.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/20/2017] [Indexed: 01/03/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common and benign condition. However, some anatomic forms have been recently associated with life-threatening ventricular arrhythmias and sudden cardiac death. Imaging MVP holds the promise of individualized MVP risk assessment. Noninvasive imaging techniques available today are playing an increasingly important role in the diagnosis, prognosis and monitoring of MVP. In this article, we will review the current evidence on arrhythmogenic MVP, with special focus on the utility of echocardiography and CMR for identifying benign and "malignant" forms of MVP. The clinical relevance of this manuscript lies in the value of imaging technology to improve MVP risk prediction, including those arrhythmic-MVP cases with a higher risk of sudden cardiac death.
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Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | | | - Luca Vannini
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Rey Juan Carlos (PhD Etudent in Epidemiology and Public Health), Madrid
| | - Ana Fidalgo Argüelles
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | | | - Jorge Solís
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
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Capdeville M, Alfirevic A. A Game of Twister: What 3D TEE Rendering Tells Us About the Mitral Annulus During OPCAB. J Cardiothorac Vasc Anesth 2018; 32:341-343. [DOI: 10.1053/j.jvca.2017.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 11/11/2022]
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Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, Enriquez-Sarano M. Pathophysiology of Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2018; 11:e005971. [DOI: 10.1161/circimaging.116.005971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Clemence Antoine
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Francesca Mantovani
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Giovanni Benfari
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Sunil V. Mankad
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Joseph F. Maalouf
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Hector I. Michelena
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Maurice Enriquez-Sarano
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
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Carbone A, D'Andrea A, Scognamiglio G, Scarafile R, Tocci G, Sperlongano S, Martone F, Radmilovic J, D'Amato M, Liccardo B, Scherillo M, Galderisi M, Golino P. Mitral Prolapse: An Old Mysterious Entity - The Incremental Role of Multimodality Imaging in Sports Eligibility. J Cardiovasc Echogr 2018; 28:207-217. [PMID: 30746324 PMCID: PMC6341849 DOI: 10.4103/jcecho.jcecho_42_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Mitral valve prolapse is generally a benign condition characterized by fibromyxomatous changes of the mitral leaflet with displacement into the left atrium and late-systolic regurgitation. Although it is an old clinical entity, it still arouses perplexity in diagnosis and clinical management. Complications, such as mitral regurgitation (MR), atrial fibrillation, congestive heart failure, endocarditis, ventricular arrhythmias, and sudden cardiac death (SCD), have been reported. A large proportion of the overall causes of SCD in young competitive athletes is explained by mitral valve prolapse. Recent studies have shown the fibrosis of the papillary muscles and inferobasal left ventricular wall in mitral valve prolapse, suggesting a possible origin of ventricular fatal arrhythmias. Athletes with mitral valve prolapse and MR should undergo annual evaluations including physical examination, echocardiogram, and exercise stress testing to evaluate the cardiovascular risks of competitive sports and obtain the eligibility. In this setting, multimodality imaging techniques – echocardiography, cardiac magnetic resonance, and cardiac computed tomography – should provide a broad spectrum of information, from diagnosis to clinical management of the major clinical profiles of the disease.
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Affiliation(s)
- Andreina Carbone
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Antonello D'Andrea
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | | | - Raffaella Scarafile
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Gianpaolo Tocci
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Simona Sperlongano
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Francesca Martone
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Juri Radmilovic
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Marianna D'Amato
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Biagio Liccardo
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico Ii University of Naples, Naples, Italy
| | - Paolo Golino
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
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Abstract
Mitral regurgitation (MR) is the most prevalent cause of valvular heart disease (VHD) in western countries. In the Euro Heart Survey on VHD, MR was the second most common heart VHD requiring surgery. It is also the most common form of VHD in community and population-based studies from the United States. The categorization of MR based on causes and mechanisms is a major determinant of clinical outcome, of possible therapies for the MR and of the effectiveness of these therapies. Surgical mitral valve (MV) repair has been shown to improve survival in patients with severe primary MR compared with MV replacement. In addition, new percutaneous repair and replacement procedures have been recently developed. Hence, accurate understanding of the functional anatomy of the MV and the pathophysiologic principles underlying MR is needed to appropriately target valve lesions. Recent advances in cardiac imaging have allowed to deeply strengthen the knowledge of the function of the MV. The present review aims at describing the functional anatomy and pathophysiology of MR through different cardiac imaging modalities.
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78
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Lee APW, Jin CN, Fan Y, Wong RH, Underwood MJ, Wan S. Functional Implication of Mitral Annular Disjunction in Mitral Valve Prolapse. JACC Cardiovasc Imaging 2017; 10:1424-1433. [DOI: 10.1016/j.jcmg.2016.11.022] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/01/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
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79
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Deorsola L, Bellone A. Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry? Echocardiography 2017; 35:30-38. [DOI: 10.1111/echo.13727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Luca Deorsola
- Pediatric Cardiac Surgery Department; Regina Margherita Children's Hospital; Turin Italy
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80
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Abstract
PURPOSE OF REVIEW The purpose of this review was to elucidate the additional value of 3D echocardiography for the assessment of mitral regurgitation (MR) compared to standard 2D echocardiography. RECENT FINDINGS 3D echocardiography provides key information, aetiology, degenerative mitral valve disease vs. secondary MR, causes and mechanism, severity by measurements of effective regurgitant orifice area and regurgitant volume; likelihood of reparability and assessment of pre- and intra-mitral valve transcatheter procedures. 3D echocardiography as a promising method for assessment of MR is useful and crucial for research, clinical practice and patient management in all heart valve team members.
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81
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Cho EJ, Park SJ, Lee GY, Kim EK, Chang SA, Choi JO, Lee SC, Park SW, Park PW. Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography. J Cardiovasc Ultrasound 2017; 25:47-56. [PMID: 28770032 PMCID: PMC5526885 DOI: 10.4250/jcu.2017.25.2.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background The extent of mitral annular (MA) remodeling and dysfunction is correlated with the severity of mitral regurgitation (MR) as well as left atrial (LA) and left ventricular (LV) dilation. MA dysfunction may be a useful prognostic factor for operative timing and MR recurrence after successful mitral valve (MV) repair. The aim of this study was to evaluate additive prognostic factors of MA non-planarity using real-time 3D transesophageal echocardiography (RT3D-TEE) analysis in patients with chronic severe MR and preserved LV systolic function. Methods Forty-seven patients with chronic severe MR and preserved LV systolic function scheduled for MV repair were prospectively enrolled. Echocardiographic studies were performed before surgery and postoperatively within 2 weeks and at least 6 months after surgery. RT3D-TEE was performed before the operation and immediately post-operative. Results Mean age was 55.4 ± 15.1 years and 24 were male. Annulus height/body surface area (BSA) obtained via RT3D-TEE was correlated with the degree of postoperative LA remodeling. Patients were divided into two groups by average baseline annulus height/BSA. Patients with normal annular height had a smaller postoperative LV end-diastolic dimension, LV end-systolic dimension and LA volume index than patients with decreased annular height. Preoperative annulus height/BSA values strongly predicted postoperative LA remodeling. Conclusion MA height may be a useful prognostic factor for determining the timing of surgery in patients with chronic primary MR. Annulus height/BSA assessed via RT3D-TEE may provide additional information predictive of postoperative LA remodeling after successful MV repair.
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Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Yeon Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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82
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Mak GJ, Blanke P, Ong K, Naoum C, Thompson CR, Webb JG, Moss R, Boone R, Ye J, Cheung A, Munt B, Leipsic J, Grewal J. Three-Dimensional Echocardiography Compared With Computed Tomography to Determine Mitral Annulus Size Before Transcatheter Mitral Valve Implantation. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004176. [PMID: 27307549 DOI: 10.1161/circimaging.115.004176] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previously, through the use of computed tomography (CT), it has been proposed that D-shaped versus saddle-shaped mitral annulus (MA) segmentation is more biomechanically appropriate to determine transcatheter mitral valve implantation size and eligibility. METHODS AND RESULTS Forty-one patients with severe mitral regurgitation being considered for transcatheter mitral valve implantation who had undergone cardiac CT and 3-dimensional transesophageal echocardiography (3D-TEE) were retrospectively evaluated. A standardized segmentation protocol for the D-shaped MA was developed using Philips Q-Laboratory mitral valve quantification software. MA dimensions were compared using Spearman's rank correlation and Bland-Altman analysis. Inter- and intraobserver agreement was quantified by intraclass correlation coefficient and Bland-Altman analysis. Mean age was 77±14 years; 71% male (n=29); mitral regurgitation pathogenesis was functional in 54% (n=22) and myxomatous in 46% (n=19). Mean MA area and circumference by 3D-TEE and CT were 11.3±2.7 versus 11.4±3.0 (P=0.67) and 124.1±15.6 versus 123.9±15.5 (P=0.79), respectively, with excellent correlation between modalities (r=0.84 and r=0.86; P<0.0001) and no systematic bias (-0.20±1.8 cm(2) [-3.7 cm(2); 3.3 cm(2)], 0.37±9 mm [-18.0 mm; 17.27 mm]). Mean septal-to-lateral and inter-trigone distances by 3D-TEE and CT were 33.2±4.7 versus 32.5±4.4 (P=0.24) and 31.7±3.5 versus 32.6±3.6 (P=0.06), respectively, with good correlation (r=0.69 and r=0.71; P<0.0001) and no systematic bias (0.77±3.8 mm [-6.7 mm; 8.2 mm], -1.5±3.1 mm [-4.6 mm; 7.6 mm]). There was excellent intra- and interobserver agreement according to intraclass correlation coefficients >0.90 for all parameters. CONCLUSIONS Similar to cardiac CT, 3D-TEE allows for D-shaped MA segmentation with no systematic difference in MA dimensions between modalities. This study supports the utilization of 3D-TEE as a complementary tool to CT assessment of the D-shaped MA to determine transcatheter mitral valve implantation size.
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Affiliation(s)
- George J Mak
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Kevin Ong
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Christopher Naoum
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - John G Webb
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Robert Moss
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Robert Boone
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Anson Cheung
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Brad Munt
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jasmine Grewal
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada.
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83
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Jolley MA, Ghelani SJ, Adar A, Harrild DM. Three-Dimensional Mitral Valve Morphology and Age-Related Trends in Children and Young Adults with Structurally Normal Hearts Using Transthoracic Echocardiography. J Am Soc Echocardiogr 2017; 30:561-571. [PMID: 28391001 DOI: 10.1016/j.echo.2017.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The mitral valve has a complex three-dimensional (3D) morphology that is incompletely described by two-dimensional echocardiography (echo). Three-dimensional echo provides a more robust tool to analyze the mitral valve. The shape of the mitral annulus and leaflets, and differences with age, have not been described by 3D echo in normal children. Our objective was to characterize and quantify the 3D mitral valve morphology in children with normal transthoracic echocardiograms over a broad spectrum of age and to identify differences in valve shape with age. METHODS Three-dimensional midsystolic mitral valve models were constructed in 100 children and young adults with normal echocardiograms using 3D transthoracic images. Annular and leaflet metrics were quantified and regression equations were prepared. Interuser and intrauser variability was measured. RESULTS Two hundred fifty patients, from neonate to young adult, were retrospectively reviewed to obtain 100 evaluable patients (40% evaluable). The annular height to commissural width ratio of the mitral valve ("saddle shape") was preserved across age (median 24.3, IQR 21.8-28.1). Three-dimensional mitral valve area, length, and volume parameters were linearly related to body surface area (P < .001). The ratio of anterior to posterior leaflet length and posterior leaflet angle increased with body surface area (P = .0004 and .002, respectively) suggesting posterior movement of the coaptation line. Two-dimensional lateral annular diameter underestimated 3D lateral annular metrics (P < .001, mean difference 20-22%) but was highly correlated (R > 0.87, P < .001). Interuser and intrauser variability were acceptable. CONCLUSIONS Assessment of 3D mitral valve morphology in children is possible in a modern clinical pediatric echocardiography laboratory using transthoracic images, although further optimization of imaging is needed. The saddle shape of the mitral annulus was preserved across age and size. Most mitral valve parameters increased linearly with patient size. Further investigation is warranted to explore changes in valve morphology in the pediatric population in health and with disease.
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Affiliation(s)
- Matthew A Jolley
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Cardiac Anesthesia and Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Adi Adar
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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84
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Menciotti G, Borgarelli M, Aherne M, Wesselowski S, Häggström J, Ljungvall I, Lahmers S, Abbott J. Mitral valve morphology assessed by three-dimensional transthoracic echocardiography in healthy dogs and dogs with myxomatous mitral valve disease. J Vet Cardiol 2017; 19:113-123. [DOI: 10.1016/j.jvc.2017.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/12/2016] [Accepted: 01/02/2017] [Indexed: 01/15/2023]
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85
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Sturla F, Onorati F, Puppini G, Pappalardo OA, Selmi M, Votta E, Faggian G, Redaelli A. Dynamic and quantitative evaluation of degenerative mitral valve disease: a dedicated framework based on cardiac magnetic resonance imaging. J Thorac Dis 2017; 9:S225-S238. [PMID: 28540065 DOI: 10.21037/jtd.2017.03.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate quantification of mitral valve (MV) morphology and dynamic behavior over the cardiac cycle is crucial to understand the mechanisms of degenerative MV dysfunction and to guide the surgical intervention. Cardiac magnetic resonance (CMR) imaging has progressively been adopted to evaluate MV pathophysiology, although a dedicated framework is required to perform a quantitative assessment of the functional MV anatomy. METHODS We investigated MV dynamic behavior in subjects with normal MV anatomy (n=10) and patients referred to surgery due to degenerative MV prolapse, classified as fibro-elastic deficiency (FED, n=9) and Barlow's disease (BD, n=10). A CMR-dedicated framework was adopted to evaluate prolapse height and volume and quantitatively assess valvular morphology and papillary muscles (PAPs) function over the cardiac cycle. Multiple comparison was used to investigate the hallmarks associated to MV degenerative prolapse and evaluate the feasibility of anatomical and functional distinction between FED and BD phenotypes. RESULTS On average, annular dimensions were significantly (P<0.05) larger in BD than in FED and normal subjects while no significant differences were noticed between FED and normal. MV eccentricity progressively decreased passing from normal to FED and BD, with the latter exhibiting a rounder annulus shape. Over the cardiac cycle, we noticed significant differences for BD during systole with an abnormal annular enlargement between mid and late systole (LS) (P<0.001 vs. normal); the PAPs dynamics remained comparable in the three groups. Prolapse height and volume highlighted significant differences among normal, FED and BD valves. CONCLUSIONS Our CMR-dedicated framework allows for the quantitative and dynamic evaluation of MV apparatus, with quantifiable annular alterations representing the primary hallmark of severe MV degeneration. This may aid surgeons in the evaluation of the severity of MV dysfunction and the selection of the appropriate MV treatment.
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Affiliation(s)
- Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Radiology, Università degli Studi di Verona, Verona, Italy
| | - Omar A Pappalardo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Matteo Selmi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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86
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El Sebaie MH, Abdelatti M, Zarea A, Farag A, Hashem A, Fadel A. Assessment of mitral valve geometric deformity in patients with ischemic heart disease using three-dimensional echocardiography. Egypt Heart J 2017; 69:13-20. [PMID: 29622950 PMCID: PMC5839364 DOI: 10.1016/j.ehj.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/14/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A full understanding of the geometry of the nonplanar saddle-shaped mitral annulus can provide valuable information regarding the pathophysiology of mitral regurgitation (MR). AIM OF THE WORK To investigate mitral annular geometric deformities using three-dimensional echocardiography among patients with ischemic coronary illness with and without mitral regurgitation. METHODS Three-dimensional transesophageal echocardiographic data were acquired intraoperatively from patients with ischemic heart disease with or without associated mitral regurgitation who experienced coronary artery bypass grafting and normal control subjects. The mitral annulus was analyzed for differences in geometry using QLAB software. RESULTS Left ventricular ejection fraction was reduced in patients with ischemic heart disease and MR (n = 21; Group 1) and without MR (n = 7; Group 2) compared with that in normal subjects (n = 14; Group 3) (43.4% ± 11.8% and 35.9% ± 13.6% vs. 52.6% ± 9.3%, respectively; p = 0.015). Mitral annular height and mitral annular saddle-shaped nonplanarity were significantly lower in Group 1 compared to Group 2 and Group 3 (6.00 ± 1.07 mm, 7.96 ± 0.93 mm and 8.31 ± 1.12 mm; p < 0.0001) and (0.19 ± 0.04, 0.26 ± 0.04 and 0.26 ± 0.03; p < 0.0001) respectively while mitral annular ellipsicity and Mitral valve tenting volume were significantly higher in the same group (1) (114.82% ± 22.47%, 100.21% ± 9.87% and 97.29% ± 14.37%; p = 0.0421) and (2.73 ± 1.11, 2.20 ± 1.39 and 0.87 ± 0.67) respectively. Vena contracta diameter was inversely correlated with the mitral annular height (r = -0.82; p < 0.0001) and saddle-shaped nonplanarity of the annulus (r = -0.68; p < 0.0001). CONCLUSION Among patients with ischemic heart disease, there are significant increases in mitral valve tenting volume and height, and those with mitral regurgitation exhibited a reduced mitral annular height, a shallower saddle shape annulus and losses of ellipsicity of the annulus.
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Affiliation(s)
- Maha H. El Sebaie
- Cardiology Department, Zagazig University, Egypt
- King Abdulla Medical City, Saudi Arabia
| | - M.N. Abdelatti
- Anesthesia Department, King Abdulla Medical City, Saudi Arabia
| | - A.A. Zarea
- Anesthesia Department, King Abdulla Medical City, Saudi Arabia
| | - A.M. Farag
- Anesthesia Department, King Abdulla Medical City, Saudi Arabia
| | - A.A. Hashem
- Anesthesia Department, King Abdulla Medical City, Saudi Arabia
| | - A.M. Fadel
- Anesthesia Department, King Abdulla Medical City, Saudi Arabia
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87
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van Wijngaarden SE, Kamperidis V, Regeer MV, Palmen M, Schalij MJ, Klautz RJ, Bax JJ, Ajmone Marsan N, Delgado V. Three-dimensional assessment of mitral valve annulus dynamics and impact on quantification of mitral regurgitation. Eur Heart J Cardiovasc Imaging 2017; 19:176-184. [DOI: 10.1093/ehjci/jex001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
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88
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Kim MJ, Jung HO. Pulmonary hypertension: a long-term risk stratifier in primary mitral regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:541. [PMID: 28149902 DOI: 10.21037/atm.2016.11.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mi-Jeong Kim
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hae Ok Jung
- Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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89
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Hayashi A, Fukuda S, Mahara K, Hei S, Onoue T, Kado Y, Nagata Y, Iwataki M, Otani K, Miyamoto T, Oginosawa Y, Sonoda S, Eto M, Nishimura Y, Takanashi S, Levine RA, Otsuji Y. Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse - Three-Dimensional Echocardiography. Circ J 2016; 80:2533-2540. [PMID: 27829586 DOI: 10.1253/circj.cj-16-0694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Segmental and global mitral valve prolapse (MVP) comprise 2 representative phenotypes in this syndrome. While mitral regurgitation (MR) severity is a major factor causing left atrial (LA) remodeling in MVP, prominent mitral valve (MV) annulus dilatation in global MVP may specifically cause inferiorly predominant LA remodeling. We compared MV annulus and LA geometry in patients with segmental and global MVP.Methods and Results:LA volume as well as inferior, middle, and superior LA cross-sectional areas (CSA) were measured on 3-D echocardiography in 20 controls, in 40 patients with segmental MVP, and in 18 with global MVP. On multivariate analysis, MR severity was primarily associated with LA dilatation in segmental MVP (P<0.001), while MV annular dilatation was primarily associated with LA dilatation in global MVP (P<0.001). Although there was no regional predominance in LA dilatation in segmental MVP, inferior predominance of LA dilatation was significant in global MVP (increase in inferior, middle, and superior LA-CSA relative to mean of the controls: +220±70% vs. +171±55% vs. +137±37%, P<0.001). CONCLUSIONS LA remodeling in segmental and global MVP is considerably different regarding its association with MR volume or MV annular dilatation and its regional predominance. While MR volume may mainly contribute to LA remodeling in segmental MVP, MV annular dilatation seems to have an important role in LA remodeling in global MVP. (Circ J 2016; 80: 2533-2540).
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Affiliation(s)
- Atsushi Hayashi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
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90
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Fukuda S, Song JK, Mahara K, Kuwaki H, Jang JY, Takeuchi M, Sun BJ, Kim YJ, Miyamoto T, Oginosawa Y, Sonoda S, Eto M, Nishimura Y, Takanashi S, Levine RA, Otsuji Y. Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.005113. [DOI: 10.1161/circimaging.115.005113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
Background—
Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace’s law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction.
Methods and Results—
Echocardiography with speckle-tracking analysis to assess regional cross-sectional short-axis area and longitudinal contraction (strain) of basal, middle, and apical LV was performed in 30 controls and 130 patients with MVP. The basal value/averaged middle and apical values (B/M·A ratio) of LV cross-sectional area and strain were obtained. Patients with MVP showed significantly greater MV annular area (6.4±1.6 versus 3.7±0.6 cm
2
/m
2
), increased B/M·A LV area ratio (2.4±0.5 versus 1.8±0.2), and reduced B/M·A LV strain ratio (0.83±0.14 versus 0.96±0.09) than controls (
P
<0.001). Multivariable analyses identified that MV annular dilatation was independently associated with increased B/M·A LV area ratio (β=0.60,
P
<0.001), which was associated with reduced B/M·A LV strain ratio (β=−0.32,
P
<0.001). In 35 patients with MVP, B/M·A LV area and strain ratio significantly altered after surgical MV plasty with annulus reduction (2.5±0.5–1.8±0.3 and 0.73±0.10–0.89±0.17,
P
<0.001, respectively).
Conclusions—
In patients with MVP, MV annular dilatation was associated with the basal predominance of LV dilatation and reduced contraction, which can be altered by surgical MV plasty with annulus reduction, suggesting unfavorable influence from MV annular dilatation on basal LV.
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Affiliation(s)
- Shota Fukuda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jae-Kwan Song
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Keitaro Mahara
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Hiroshi Kuwaki
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jeong Yoon Jang
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masaaki Takeuchi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Byung Joo Sun
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yun Jeong Kim
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Tetsu Miyamoto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yasushi Oginosawa
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shinjo Sonoda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masataka Eto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yosuke Nishimura
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shuichiro Takanashi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Robert A. Levine
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yutaka Otsuji
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
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91
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Jin CN, Salgo IS, Schneider RJ, Kam KKH, Chi WK, So CY, Tang Z, Wan S, Wong R, Underwood M, Lee APW. Using Anatomic Intelligence to Localize Mitral Valve Prolapse on Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29:938-945. [DOI: 10.1016/j.echo.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Indexed: 10/21/2022]
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92
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Apor A, Nagy AI, Kovács A, Manouras A, Andrássy P, Merkely B. Three-dimensional dynamic morphology of the mitral valve in different forms of mitral valve prolapse - potential implications for annuloplasty ring selection. Cardiovasc Ultrasound 2016; 14:32. [PMID: 27528216 PMCID: PMC4986382 DOI: 10.1186/s12947-016-0073-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/25/2016] [Indexed: 02/02/2023] Open
Abstract
Background Real-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. Methods In 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. Results Geometric 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). Conclusion BD 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.
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Affiliation(s)
- Astrid Apor
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary.
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
| | | | - Péter Andrássy
- Bajcsy-Zsilinszky Hospital and Clinic, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
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93
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Wan S, Lee AP, Attaran S, Yu PS, Au SS, Kwok MW, Lau RW, Wong RH, Wan IY, Ng SK, Underwood MJ. Mitral valve repair using a semirigid ring: patient selection and early outcomes. Asian Cardiovasc Thorac Ann 2016; 24:647-52. [PMID: 27448551 DOI: 10.1177/0218492316659970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. METHODS We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. RESULTS Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. CONCLUSIONS Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
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Affiliation(s)
- Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex Pw Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Saina Attaran
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter Sy Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sylvia Sw Au
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Micky Wt Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow Wh Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph Hl Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Yp Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Siu-Keung Ng
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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94
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Ghulam Ali S, Fusini L, Tamborini G, Muratori M, Gripari P, Mapelli M, Zanobini M, Alamanni F, Pepi M. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair. Am J Cardiol 2016; 118:113-20. [PMID: 27184171 DOI: 10.1016/j.amjcard.2016.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing.
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95
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Menciotti G, Borgarelli M, Aherne M, Häggström J, Ljungvall I, Lahmers S, Abbott J. Assessment of mitral valve morphology using three-dimensional echocardiography. Feasibility and reference values. J Vet Cardiol 2016; 18:156-67. [DOI: 10.1016/j.jvc.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 01/04/2023]
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96
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Comparison of saddle-shape flexibility and elliptical-shape stability between Cosgrove-Edwards and Memo-3D annuloplasty rings using three-dimensional analysis software. Gen Thorac Cardiovasc Surg 2016; 64:325-32. [PMID: 27052546 DOI: 10.1007/s11748-016-0645-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare three-dimensional dynamics between implanted Cosgrove-Edwards and Sorin Memo-3D annuloplasty rings during the cardiac cycle. METHODS We examined 11 Cosgrove-Edwards rings and 20 Sorin Memo-3D rings after mitral plasty using real-time three-dimensional transesophageal echocardiography. We evaluated ring height, ellipticity, and geometry during one cardiac cycle. Four evenly spaced phases each selected during systole and diastole were assessed using REAL VIEW software. RESULTS The height of the Cosgrove-Edwards and Sorin Memo-3D rings was similar (2.3 ± 0.8 vs. 1.9 ± 0.9 mm, p = 0.44). The maximum difference in ring height during one cardiac cycle (change in height) was larger for the Cosgrove-Edwards than the Sorin Memo-3D rings (2.3 ± 0.8 vs. 1.5 ± 0.6 mm, p = 0.014). Ellipticity and the maximum difference in ellipticity during one cardiac cycle (change in ellipticity) were larger for Cosgrove-Edwards than Sorin Memo-3D rings (80.0 ± 9.1 vs. 72.0 ± 4.8 %, p = 0.014, respectively, and 12.0 ± 3.1 vs. 6.0 ± 1.8 %, p < 0.001). CONCLUSIONS Cosgrove-Edwards rings were more flexible, whereas Sorin Memo-3D rings maintained the elliptical shape more effectively.
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97
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Boudoulas KD, Pitsis AA, Boudoulas H. Floppy Mitral Valve (FMV) – Mitral Valve Prolapse (MVP) – Mitral Valvular Regurgitation and FMV/MVP Syndrome. Hellenic J Cardiol 2016; 57:73-85. [DOI: 10.1016/j.hjc.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022] Open
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98
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Mihaila S, Muraru D, Miglioranza MH, Piasentini E, Aruta P, Cucchini U, Iliceto S, Vinereanu D, Badano LP. Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodelling in patients with primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2016; 17:918-29. [PMID: 26758410 DOI: 10.1093/ehjci/jev301] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/09/2015] [Indexed: 01/18/2023] Open
Abstract
AIMS To explore the relationship between the mitral annular (MA) remodelling and dysfunction, mitral regurgitation (MR) severity, left ventricular (LV) and atrial (LA) size and function in patients with organic MR (OMR). METHODS AND RESULTS A total of 52 patients (57 ± 15 years, 31 men) with mild to severe OMR and 52 controls underwent 3D transthoracic echocardiography acquisitions of the mitral valve (MV), LA, and LV. MA geometry and dynamics, LV and LA volumes, LV ejection fraction (LVEF) and emptying fractions (LAEF) were assessed using dedicated software packages. LA and LV myocardial deformations were assessed using 2D speckle-tracking echocardiography. OMR patients presented larger and more spherical MA than controls during the entire systole (P < 0.001). Although the MA non-planarity at early-systole was similar between OMR and controls (157 ± 13° vs. 153 ± 12°, P = NS), the MA became flatter from mid- to end-systole (153 ± 12 vs. 146 ± 10° and 157 ± 12 vs. 147 ± 8°, P < 0.01) in OMR. MA area fractional change was lower in patients with OMR (22 ± 5% vs. 28 ± 5%, P < 0.001), and correlated with the MR orifice and volume (r = -0.52 and r = -0.55). MA fractional area change correlated with LA minimum and maximum volumes (r = 0.77 and r = 0.70), total and active LAEF (r = 0.72 and r = 0.76), and LA negative strain and strain rate (r = 0.52 and r = 0.57), but not with the LVEF or LV global longitudinal strain. In a multivariate regression model using LAEF and LVEF, solely active LAEF correlated with the MA fractional area change (β = 0.51, P = 0.005). CONCLUSION In patients with OMR, MA reduced function correlates with the MR severity and the LA size and function, but not with the LV function.
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Affiliation(s)
- Sorina Mihaila
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
| | - Marcelo Haertel Miglioranza
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eleonora Piasentini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
| | - Patrizia Aruta
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
| | - Umberto Cucchini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
| | - Dragos Vinereanu
- University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy
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Nishi H, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Kawamura M, Yoshioka D, Saito T, Ueno T, Kuratani T, Sawa Y. Annular dynamics after mitral valve repair with different prosthetic rings: A real-time three-dimensional transesophageal echocardiography study. Surg Today 2015; 46:1083-90. [PMID: 26687280 DOI: 10.1007/s00595-015-1279-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE We assessed the effects of different types of prosthetic rings on mitral annular dynamics using real-time three-dimensional echocardiography (RT3DE). METHODS RT3DE was performed in 44 patients, including patients undergoing mitral annuloplasty using the Cosgrove-Edwards flexible band (Group A, n = 10), the semi-rigid Sorin Memo 3D ring (Group B, n = 17), the semi-rigid Edwards Physio II ring (Group C, n = 7) and ten control subjects. Various annular diameters were measured throughout the cardiac cycle. RESULTS We observed flexible anterior annulus motion in all of the groups except Group C. A flexible posterior annulus was only observed in Group B and the Control group. The mitral annular area changed during the cardiac cycle by 8.4 ± 3.2, 6.3 ± 2.0, 3.2 ± 1.3, and 11.6 ± 5.0 % in Group A, Group B, Group C, and the Control group, respectively. The dynamic diastolic to systolic change in mitral annular diameters was lost in Group C, while it was maintained in Group A, and to a good degree in Group B. In comparison to the Control group, the mitral annulus shape was more ellipsoid in Group B and Group C, and more circular in Group A. CONCLUSION Although mitral regurgitation was well controlled by all of the types of rings that were utilized in the present study, we demonstrated that the annulus motion and annulus shape differed according to the type of prosthetic ring that was used, which might provide important information for the selection of an appropriate prosthetic ring.
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Affiliation(s)
- Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
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100
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Kagiyama N, Toki M, Hara M, Fukuda S, Aritaka S, Miki T, Ohara M, Hayashida A, Hirohata A, Yamamoto K, Yoshida K. Efficacy and Accuracy of Novel Automated Mitral Valve Quantification: Three-Dimensional Transesophageal Echocardiographic Study. Echocardiography 2015; 33:756-63. [DOI: 10.1111/echo.13135] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nobuyuki Kagiyama
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Misako Toki
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Masahiko Hara
- Department of Medical Innovation; Osaka University Hospital; Osaka Japan
| | - Shuichiro Fukuda
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Shingo Aritaka
- Department of Laboratory Medicine; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Tomonori Miki
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Minako Ohara
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Akihiro Hayashida
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Atsushi Hirohata
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Keizo Yamamoto
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
| | - Kiyoshi Yoshida
- Department of Cardiology; The Sakakibara Heart Institute of Okayama; Okayama Japan
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