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Toader DM. Echocardiographic quantification of mitral apparatus morphology and dynamics in patients with dilated cardiomyopathy. J Int Med Res 2024; 52:3000605231209830. [PMID: 38318649 PMCID: PMC10846232 DOI: 10.1177/03000605231209830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/09/2023] [Indexed: 02/07/2024] Open
Abstract
Mitral regurgitation is among the most common valvular heart diseases. Mitral regurgitation in patients with dilated cardiomyopathy is a complex pathology involving annular dilatation, papillary muscle displacement, systolic leaflet tethering, and left ventricular remodeling. Quantification of mitral apparatus damage in these patients is essential for successful interventional and surgical therapy. Mitral regurgitation in the presence of dilated cardiomyopathy is classified as Carpentier type IIIB, with restricted leaflet mobility as a standard feature. Echocardiography allows accurate evaluation of the complex anatomy and function of the mitral apparatus. Updated guidelines recommend two-dimensional followed by systematic three-dimensional echocardiographic evaluation in patients with mitral regurgitation. New three-dimensional echocardiographic software packages provide many parameters that help identify the precise morphology and function of the various components of the mitral apparatus, helping to determine the etiology of mitral regurgitation and evaluate disease severity. This review provides the first point-by-point approach to the assessment of all old and new echocardiographic methods, from the simplest to the most complex, used to examine the components of the mitral valve apparatus in patients with dilated cardiomyopathy. Although these parameters are still under research, this information will be helpful for establishing therapeutic procedures in a disease with a poor prognosis.
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Affiliation(s)
- Despina-Manuela Toader
- EuroEchoLab Craiova Cardiology Center, Emergency Hospital Craiova, Romania, Str Tabaci nr 1, Craiova, Romania
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2
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Cotella JI, Henry MP, Lang RM, Mor-Avi V, Asch FM. Response to "Dynamic Nature of the Mitral Valve Morphology: Consideration of the Normal Ranges". J Am Soc Echocardiogr 2023; 36:126-127. [PMID: 36243215 DOI: 10.1016/j.echo.2022.10.004] [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: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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3
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Dynamic Nature of the Mitral Valve Morphology: Consideration of the Normal Ranges. J Am Soc Echocardiogr 2023; 36:125-126. [PMID: 36122790 DOI: 10.1016/j.echo.2022.09.005] [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: 09/02/2022] [Accepted: 09/11/2022] [Indexed: 01/10/2023]
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Meyer A, Greve D, Unbehaun A, Kofler M, Kukucka M, Klein C, Knierim J, Emmert MY, Falk V, Kempfert J, Sündermann SH. Transcatheter aortic valve implantation and its impact on mitral valve geometry and function. J Card Surg 2020; 35:2185-2193. [PMID: 32652711 DOI: 10.1111/jocs.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function. METHODS Eighty-four patients underwent TAVI. Forty-four (52%) patients received a balloon-expandable valve and 40 (48%) were implanted with a self-expandable valve. All patients underwent three-dimensional-volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry. RESULTS During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm2 vs 9.9 ± 2.6cm2 ; P < .05) as well as the tenting area (1.6 ± 0.7 cm2 vs 1.2 ± 0.6 cm2 ; P < .001) measured at mid-systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon-expandable valves showed a significantly larger reduction in the AP diameter compared to self-expandable valves (-0.25 cm vs -0.11 cm; P < .05). The reduction of the annular area was higher in the balloon-expandable group (-1.2 ± 1.59 vs -0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI. CONCLUSION TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon- vs self-expandable) may be relevant for those changes.
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Affiliation(s)
- Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Dustin Greve
- Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Institute of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Christoph Klein
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany.,Department of Health Science Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
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Hübscher A, Schwerg M, Hoffmann S, Baldenhofer G, Heupel C, Jasaityte R, Kruck S, Stangl K, Dreger H, Knebel F. Automated quantification of mitral valve tenting volume in functional mitral regurgitation by three‐dimensional echocardiography. Echocardiography 2020; 37:1043-1048. [DOI: 10.1111/echo.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anne Hübscher
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Marius Schwerg
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Saskia Hoffmann
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Gerd Baldenhofer
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Christian Heupel
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Ruta Jasaityte
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim Bietigheim‐Bissingen Germany
| | - Karl Stangl
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Henryk Dreger
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Fabian Knebel
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
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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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Dumont KA, Kvitting JPE, Karlsen JS, Remme EW, Hausken J, Lundblad R, Fiane AE, Urheim S. Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2018; 32:303-316.e4. [PMID: 30293779 DOI: 10.1016/j.echo.2018.08.010] [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: 05/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Three-dimensional (3D) echocardiography with multiplanar reconstruction (MPR) is used clinically to quantify the mitral annulus. MPR images are, however, presented on a two-dimensional screen, calling into question their accuracy. An alternative to MPR is an autostereoscopic holographic display that enables in-depth visualization of 3D echocardiographic data without the need for special glasses. The aim of this study was to validate an autostereoscopic display using sonomicrometry as a gold standard. METHODS In 11 anesthetized open-chest pigs, sonomicrometric crystals were placed along the mitral annulus and near the left ventricular apex. High-fidelity catheters measured left atrial and ventricular pressures. Adjustments of pre- and afterload were done by constriction of the inferior vena cava and the ascending aorta, respectively. Three-dimensional epicardial echocardiography was obtained from an apical view and converted to the autostereoscopic display. A 3D virtual semitransparent annular surface (VSAS) was generated to measure commissure width (CW), septal-lateral length, area of the mitral annular surface, nonplanarity angle, and the annular height-to-commissure width ratio in mid-systole and late diastole. RESULTS Mitral annular measurements from the 3D VSAS derived from the 3D echocardiographic images and autostereoscopic display correlated well with sonomicrometry over a range of loading conditions: CW length (r = 0.98, P < .00001), septal-lateral length (r = 0.98, P < .00001), annular surface area (r = 0.93, P < .001), nonplanarity angle (r = 0.87, P < .001), and annular height-to-commissure width ratio (r = 0.85, P < .01). The 3D VSAS showed better agreement with the sonomicrometric measurements compared with MPR. CONCLUSIONS Mitral annular measurements using 3D VSAS correlate well with sonomicrometry over a range of loading conditions and may represent a powerful tool for noninvasive quantification of mitral annular dynamics.
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Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | | | | | - Espen W Remme
- Institute for Surgical Research, The Intervention Center, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John Hausken
- Department of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Bergen, Norway
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Colli A, Besola L, Montagner M, Azzolina D, Soriani N, Manzan E, Bizzotto E, Zucchetta F, Bellu R, Pittarello D, Gerosa G. Prognostic impact of leaflet-to-annulus index in patients treated with transapical off-pump echo-guided mitral valve repair with NeoChord implantation. Int J Cardiol 2018; 257:235-237. [PMID: 29398137 DOI: 10.1016/j.ijcard.2018.01.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/10/2017] [Accepted: 01/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The transapical echo-guided NeoChord repair is a procedure to correct mitral regurgitation (MR) without the need for concomitant annuloplasty for degenerative mitral valve (MV) disease. Lacking strict criteria to define normal annular dimensions for patients undergoing MV repair, we consequently missed having precise selection criteria to identify patients who can benefit from a ringless procedure with respect to who would need a combined annular and leaflet repair. The aim of this study is to identify whether a new preoperative echocardiographic index may predict postoperative outcomes after NeoChord repair. METHODS All consecutive patients with posterior leaflet disease who underwent NeoChord repair between November 2013 and January 2016 presenting complete postoperative echocardiographic assessment up to 1year were included. Leaflet-to-Annulus Index (LAI) was defined as the ratio between the sum of anterior leaflet length (AML) and posterior leaflet length (PML) over antero-posterior length (AP; AML+PML/AP). Measurements were performed with 2D transesophageal echocardiography. RESULTS Sixty-six patients were enrolled. At 1year MR was absent in (24) 38% of patients, mild in (28) 44%, moderate in (10) 16% and severe in (1) 2%. Logistic regression analysis identified LAI as positive prognostic predictor of MR≤mild for values >1.35 at 3months, 1.30 at 6months and 1.25 at 1year. At 30days LAI was not associated with the grade of residual MR. CONCLUSIONS LAI is a positive postoperative predictor of MR≤mild at 1-year follow-up and can be used to identify patients who could benefit from a ringless NeoChord repair procedure for the absence of a leaflet-to-annulus mismatch.
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Affiliation(s)
- Andrea Colli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
| | - Laura Besola
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Matteo Montagner
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Danila Azzolina
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Nicola Soriani
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Erica Manzan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Eleonora Bizzotto
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Fabio Zucchetta
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Roberto Bellu
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
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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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10
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Jin CN, Salgo IS, Schneider RJ, Feng W, Meng FX, Kam KKH, Chi WK, So CY, Chan C, Sun JP, Tsui G, Wong KYK, Yu CM, Wan S, Wong R, Underwood M, Au S, Ng SK, Lee APW. Automated quantification of mitral valve anatomy using anatomical intelligence in three-dimensional echocardiography. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dumont KA, Karlsen JS, Helle-Valle T, Fiane AE, Lundblad R, Urheim S. Mitral valve analysis adding a virtual semi-transparent annulus plane for detection of prolapsing segments. Cardiovasc Ultrasound 2015; 13:25. [PMID: 25986226 PMCID: PMC4445285 DOI: 10.1186/s12947-015-0019-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background We hypothesized that a novel three-dimensional virtual semi-transparent annulus plane (3D VSAP) presented on a holographic screen can be used to visualize the prolapsing tissue in degenerative mitral valve disease and furthermore, provide us with geometrical data of the mitral valve apparatus. Phantom and patient studies were designed to demonstrate the feasibility of creating a semi-automatic, semi-transparent mitral annulus plane visualized on a holographic display. Methods Ten pipe cleaners mimicking the mitral annulus with different shapes and three types of annuloplasty rings served as phantoms. We obtained 3D transoesophageal examination of the phantoms in a special designed box filled with water. Recordings were converted to the holographic display and a 3D VSAP was created. The ratio of the major and minor axes as well as the non-planar angles were calculated and compared with direct measures of the phantoms. Forty patients with degenerative mitral valve disease were then analyzed with 3D transthoracic echocardiography (TTE) and a 3D VSAP was created on the holographic display. A total of 240 segments were analyzed by two independent observers, one echo expert (observer I), and the other novice with limited echo experience (observer II). The two observers created the 3D VSAP in each patient before suggesting the valve pathology. Results The major/minor axes ratio and non-planar angles by 3D VSAP correlated with direct measurements by r = 0.65, p < 0.02 and r = 0.99, p < 0.0001, respectively. The sensitivity and specificity of the 3D VSAP method in patients was 81 and 97 %, respectively (observer I) and for observer II 77 and 96 %, respectively. The accuracy and precisions were 93.9 and 89.4 %, respectively (observer I), 92.3 and 85.1 % (observer II). Mitral valve analysis adding a 3D VSAP was feasible with high accuracy and precision, providing a quick and less subjective method for diagnosing mitral valve prolapse. This novel method may improve preoperative diagnostics and may relieve a better understanding of the pathophysiology of mitral valve disease. Thus, based on the specific findings in each patient, a tailored surgical repair can be planned and hopefully enhance long-term repair patency in the future.
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Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | | | - Thomas Helle-Valle
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Post Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Arnt Eltvedt Fiane
- Department of Cardiothoracic Surgery and Faculty of Medicine in Oslo, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Stig Urheim
- Department of Cardiology and Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
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13
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Abstract
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.
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Affiliation(s)
- Takahiro Shiota
- Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA
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