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Baessato F, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Mantegazza V, Baggiano A, Mushtaq S, Pepi M, Patti G, Pontone G. Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? J Cardiovasc Dev Dis 2023; 10:jcdd10040150. [PMID: 37103029 PMCID: PMC10145831 DOI: 10.3390/jcdd10040150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
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Affiliation(s)
- Francesca Baessato
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, 80636 Munich, Germany
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Correspondence:
| | - Manuela Muratori
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gloria Tamborini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Sarah Ghulam Ali
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Mantegazza
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Mauro Pepi
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Division of Cardiology, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 2012 Milan, Italy
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Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
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Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification. Diagnostics (Basel) 2021; 11:diagnostics11030467. [PMID: 33800155 PMCID: PMC7999774 DOI: 10.3390/diagnostics11030467] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 01/13/2023] Open
Abstract
Mitral valve prolapse is a common cardiac condition, with an estimated prevalence between 1% and 3%. Most patients have a benign course, but ever since its initial description mitral valve prolapse has been associated to sudden cardiac death. Although the causal relationship between mitral valve prolapse and sudden cardiac death has never been clearly demonstrated, different factors have been implicated in arrhythmogenesis in patients with mitral valve prolapse. In this work, we offer a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and we focus on the state-of-the-art imaging-based diagnosis of mitral valve prolapse. Going beyond the classical, well-described clinical factors, such as young age, female gender and auscultatory findings, we investigate multimodality imaging features, such as alterations of anatomy and function of the mitral valve and its leaflets, the structural and contractile anomalies of the myocardium, all of which have been associated to sudden cardiac death.
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Corona S, Barbier P, Liu G, Annoh OA, Scorsin M, Moriggia S, Lemma M. Features of degenerative mitral valve prolapse in the North East of China: repair characteristics, and short-term follow-up results. Minerva Cardioangiol 2020; 68:453-468. [DOI: 10.23736/s0026-4725.20.05248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Diagnostic Accuracy of Transillumination in Mitral Valve Prolapse: Side-by-Side Comparison of Standard Transthoracic Three-Dimensional Echocardiography against Surgical Findings. J Am Soc Echocardiogr 2020; 34:98-100. [PMID: 33036821 DOI: 10.1016/j.echo.2020.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
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Guglielmo M, Fusini L, Muscogiuri G, Baessato F, Loffreno A, Cavaliere A, Rizzon G, Baggiano A, Rabbat MG, Muratori M, Tamborini G, Danza LML, Del Torto A, Tonet E, Viani G, Mushtaq S, Conte E, Bonalumi G, Gripari P, Zanobini M, Andreini D, Alamanni F, Pepi M, Guaricci AI, Pontone G. T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse. Eur Radiol 2020; 31:1100-1109. [PMID: 32803414 DOI: 10.1007/s00330-020-07140-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. We sought to demonstrate that T1-map and CMR-FT may identify the presence of subclinical myocardial structural changes in patients with mitral valve prolapse (MVP). METHODS Consecutive MVP patients with moderate-to-severe mitral regurgitation and comparative matched healthy subjects were prospectively enrolled and underwent CMR-FT analysis to calculate 2D global and segmental circumferential (CS) and radial strain (RS) and T1-map to determine global and segmental native T1 (nT1) values. RESULTS Seventy-three MVP patients (mean age, 57 ± 13 years old; male, 76%; regurgitant volume, 57 ± 21 mL) and 42 matched control subjects (mean age, 56 ± 18 years; male, 74%) were included. MVP patients showed a lower global CS (- 16.3 ± 3.4% vs. - 17.8 ± 1.9%, p = 0.020) and longer global nT1 (1124.9 ± 97.7 ms vs. 1007.4 ± 26.1 ms, p < 0.001) as compared to controls. Moreover, MVP patients showed lower RS and CS in basal (21.6 ± 12.3% vs. 27.6 ± 8.9%, p = 0.008, and - 13.0 ± 6.7% vs. - 14.9 ± 4.1%, p = 0.013) and mid-inferolateral (20.6 ± 10.7% vs. 28.4 ± 8.7%, p < 0.001, and - 12.8 ± 6.3% vs. - 16.5 ± 4.0%, p < 0.001) walls as compared to other myocardial segments. Similarly, MVP patients showed longer nT1 values in basal (1080 ± 68 ms vs. 1043 ± 43 ms, p < 0.001) and mid-inferolateral (1080 ± 77 ms vs. 1034 ± 37 ms, p < 0.001) walls as compared to other myocardial segments. Of note, nT1 values were significantly correlated with CS (r, 0.36; p < 0.001) and RS (r, 0.37; p < 0.001) but not with regurgitant volume. CONCLUSIONS T1-map and CMR-FT identify subclinical left ventricle tissue changes in patients with MVP. Further studies are required to correlate these subclinical tissue changes with the outcome. KEY POINTS • T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. • In MVP patients, we demonstrated a longer global nT1 with associated reduced global circumferential (CS) and radial strain (RS) as compared to control subjects. • Among MVP patients, the mid-basal left ventricle inferolateral wall showed longer nT1 with reduced CS and RS as compared to other myocardial segments. Further studies are required to correlate these subclinical tissue changes with the outcome.
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Affiliation(s)
- Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Francesca Baessato
- Divisione di Cardiologia, Dipartimento di Medicina, Università degli Studi, Verona, Italy
| | - Antonella Loffreno
- U.O.C. Cardiologia 1, Ospedale di Circolo e Fondazione Macchi, Università degli Studi, Varese, Italy
| | - Annachiara Cavaliere
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Giulia Rizzon
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA.,Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | | | - Alberico Del Torto
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Giacomo Viani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giorgia Bonalumi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Marco Zanobini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.
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Posada-Martinez EL, Ortiz-Leon XA, Ivey-Miranda JB, Trejo-Paredes MC, Chen W, McNamara RL, Lin BA, Lombo B, Arias-Godinez JA, Sugeng L. Understanding Non-P2 Mitral Regurgitation Using Real-Time Three-Dimensional Transesophageal Echocardiography: Characterization and Factors Leading to Underestimation. J Am Soc Echocardiogr 2020; 33:826-837. [PMID: 32387034 DOI: 10.1016/j.echo.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/02/2020] [Accepted: 03/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND P2 prolapse is a common cause of degenerative mitral regurgitation (MR); echocardiographic characteristics of non-P2 prolapse are less known. Because of the eccentric nature of degenerative MR jets, the evaluation of MR severity is challenging. The aim of this study was to test the hypotheses that (1) the percentage of severe MR determined by transthoracic echocardiography (TTE) would be lower compared with that determined by transesophageal echocardiography (TEE) in patients with non-P2 prolapse and also in a subgroup with "horizontal MR" (a horizontal jet seen on TTE that hugs the leaflets without reaching the atrial wall, particularly found in non-P2 prolapse) and (2) the directions of MR jets between TTE and real-time (RT) three-dimensional (3D) TEE would be discordant. METHODS One hundred eighteen patients with moderate to severe and severe degenerative MR defined by TEE were studied. The percentage of severe MR between TTE and TEE was compared in P2 and non-P2 prolapse groups and in horizontal and nonhorizontal MR groups. Additionally, differences in the directions of the MR jets between TTE and RT 3D TEE were assessed. RESULTS Eighty-six percent of patients had severe MR according to TEE. TTE underestimated severe MR in the non-P2 group (severe MR on TTE, 57%; severe MR on TEE, 85%; P < .001) but not in the P2 group (severe MR on TTE, 79%; severe MR on TEE, 91%; P = .157). Most "horizontal" MR jets were found in the non-P2 group (85%), and this subgroup showed even more underestimation of severe MR on TTE (TTE, 22%; TEE, 89%; P < .001). There was discordance in MR jet direction between two-dimensional TTE and RT 3D TEE in 41% of patients. CONCLUSIONS Non-P2 and "horizontal" MR are significantly underestimated on TTE compared with TEE. There is substantial discordance in the direction of the MR jet between RT 3D TEE and TTE. Therefore, TEE should be considered when these subgroups of MR are observed on TTE.
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Affiliation(s)
- Edith L Posada-Martinez
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Xochitl A Ortiz-Leon
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Juan B Ivey-Miranda
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Department of Cardiology, Hospital de Cardiologia Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Maria C Trejo-Paredes
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Wanwen Chen
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Robert L McNamara
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Ben A Lin
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bernardo Lombo
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Jose A Arias-Godinez
- Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Lissa Sugeng
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut.
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Koo HJ, Kang JW, Oh SY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Yang DH. Cardiac computed tomography for the localization of mitral valve prolapse: scallop-by-scallop comparisons with echocardiography and intraoperative findings. Eur Heart J Cardiovasc Imaging 2018; 20:550-557. [DOI: 10.1093/ehjci/jey139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/07/2018] [Indexed: 12/07/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
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Impact of different annuloplasty rings on geometry of the mitral annulus with fibroelastic deficiency: the significance of aorto-mitral angle. Int J Cardiovasc Imaging 2018; 34:1707-1713. [PMID: 29845584 DOI: 10.1007/s10554-018-1383-4] [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: 04/02/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
We sought to investigate the impact of full annuloplasty rings versus C-shape bands on mitral annular geometry in the presence of fibroelastic deficiency (FED), as assessed by intraoperative three-dimensional transesophageal echocardiography (3DTEE). We retrospectively selected 65 patients who underwent mitral valve repair for severe mitral regurgitation caused by FED using full rings (the Ring group, n = 30) and C-shape bands (the Band group, n = 35). 71 controls without valvular heart disease were also included. Thorough 3DTEE inspections were performed for the entire cohort to measure morphological parameters of mitral annulus before and after surgery. Mid-term repair durability and left atrial diameter were followed up. The preoperative 3DTEE parameters, including annular diameters, area, height and aorto-mitral angle, were significantly larger in the FED groups than normal, and were comparable between two groups using different annuloplasty devices. After repair, the anterior-posterior diameter, annulus circumference and area were significantly larger in the Band group than in the Ring group. The aorto-mitral angle became comparable with normal value in the Ring group (p = 0.728), but not in the Band group (p = 0.011). Follow-up echocardiographic data showed a significant correlation between postoperative aorto-mitral angle and reduced left atrial diameter at 50.3 months after surgery (r = 0.63; p < 0.001). In conclusion, compared with C-shape bands, full rings may impose less narrowing on aorto-mitral angle, which correlates well with mid-term left atrial reverse remodeling.
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