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Sharkey A, Mahmood F, Hai T, Khamooshian A, Gao Z, Amador Y, Khabbaz K. Regional geometric differences between regurgitant and non-regurgitant mitral valves in patients with coronary artery disease. Echocardiography 2023; 40:750-759. [PMID: 37002823 DOI: 10.1111/echo.15549] [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: 08/17/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Demonstrate that regional geometric differences exist between regurgitant and non-regurgitant mitral valves (MV's) in patients with coronary artery disease and due to the heterogenous and regional nature of ischemic remodeling in patients with coronary artery disease (CAD), that the available anatomical reserve and likelihood of developing mitral regurgitation (MR) is variable in non-regurgitant MV's in patients with CAD. METHODS In this retrospective, observational study intraoperative three-dimensional transesophageal echocardiographic data was analyzed in patients undergoing coronary revascularization with MR (IMR group) and without MR (NMR group). Regional geometric differences between both groups were assessed and MV reserve which was defined as the increase in antero-posterior (AP) annular diameter from baseline that would lead to coaptation failure was calculated in three zones of the MV from antero-lateral (zone 1), middle (zone 2), and posteromedial (zone 3). MEASUREMENTS AND MAIN RESULTS There were 31 patients in the IMR group and 93 patients in the NMR group. Multiple regional geometric differences existed between both groups. Most significantly patients in the NMR group had significantly larger coaptation length and MV reserve than the IMR group in zones 1 (p-value = .005, .049) and 2 (p-value = .00, .00), comparable between the two groups in zone 3 (p-value = .436, .513). Depletion of the MV reserve was associated with posterior displacement of the coaptation point in zones 2 and 3. CONCLUSIONS There are significant regional geometric differences between regurgitant and non-regurgitant MV's in patients with coronary artery disease. Due to regional variations in available anatomical reserve and the risk of coaptation failure in patients with CAD, absence of MR is not synonymous with normal MV function.
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Affiliation(s)
- Aidan Sharkey
- Department of Anesthesia Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Feroze Mahmood
- Department of Anesthesia Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ting Hai
- Department of Anesthesiology, Peking University Peoples Hospital, Beijing, China
| | - Arash Khamooshian
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Zhifeng Gao
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yannis Amador
- Department of Anesthesiology and Perioperative Medicine, Queens University, Kingston, Ontario, Canada
| | - Kamal Khabbaz
- Division of Cardiac Surgery, Roberta L Hines Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Rehman TA, Mahmood F, Sharkey A. Mitral Valve Coaptation Reserve-Identifying the At-Risk Valve. J Cardiothorac Vasc Anesth 2023; 37:698-699. [PMID: 36792461 DOI: 10.1053/j.jvca.2023.01.020] [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: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Taha A Rehman
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
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Chen X, Owen CA, Huang EC, Maggard BD, Latif RK, Clifford SP, Li J, Huang J. Artificial Intelligence in Echocardiography for Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 35:251-261. [PMID: 32962932 DOI: 10.1053/j.jvca.2020.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
Echocardiography is a unique diagnostic tool for intraoperative monitoring and assessment of patients with cardiovascular diseases. However, there are high levels of interoperator variations in echocardiography interpretations that could lead to inaccurate diagnosis and incorrect treatment. Furthermore, anesthesiologists are faced with the additional challenge to interpret echocardiography and make decisions in a limited timeframe from these complex data. The need for an automated, less operator-dependent process that enhances speed and accuracy of echocardiography analysis is crucial for anesthesiologists. Artificial intelligence is playing an increasingly important role in the medical field and could help anesthesiologists analyze complex echocardiographic data while adding increased accuracy and consistency to interpretation. This review aims to summarize practical use of artificial intelligence in echocardiography and discusses potential limitations and challenges in the future for anesthesiologists.
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Affiliation(s)
- Xia Chen
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Brittany D Maggard
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Rana K Latif
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Sean P Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Jinbao Li
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY.
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Jeganathan J, Knio Z, Amador Y, Hai T, Khamooshian A, Matyal R, Khabbaz KR, Mahmood F. Artificial intelligence in mitral valve analysis. Ann Card Anaesth 2017; 20:129-134. [PMID: 28393769 PMCID: PMC5408514 DOI: 10.4103/aca.aca_243_16] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.
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Affiliation(s)
- Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ziyad Knio
- Department of Surgery, Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Hospital México, University of Costa Rica, San José, Costa Rica
| | - Ting Hai
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Arash Khamooshian
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mahmood F, Shernan SK. Perioperative transoesophageal echocardiography: current status and future directions. Heart 2016; 102:1159-67. [DOI: 10.1136/heartjnl-2015-307962] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/15/2016] [Indexed: 11/04/2022] Open
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Schneider R, Prater D, Salgo I. Automation with Anatomical Intelligence as a Novel Pathway in Echocardiography for the Advancement of Measurements and Analysis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leite AF, Costa PHN, Barbosa LFP, Tan TC, Gelape CL, Nunes MCP. Echocardiography of a woman after valve intervention. Heart 2014; 100:1497, 1561. [PMID: 24700562 DOI: 10.1136/heartjnl-2014-305507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Anderson Ferreira Leite
- Hospital das Clinicas, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Henrique Nogueira Costa
- Hospital das Clinicas, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Timothy C Tan
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudio Leo Gelape
- Hospital das Clinicas, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Carmo Pereira Nunes
- Hospital das Clinicas, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Owais K, Kim H, Khabbaz KR, Bergman R, Matyal R, Gorman RC, Gorman JH, Hess PE, Mahmood F. In-vivo analysis of selectively flexible mitral annuloplasty rings using three-dimensional echocardiography. Ann Thorac Surg 2014; 97:2005-10. [PMID: 24612703 DOI: 10.1016/j.athoracsur.2014.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Selectively flexible rings, Colvin-Galloway (CG) Future and Carpentier-Edwards (CE) Physio II, are used for annuloplasty during mitral valve repair to facilitate dynamic annular motion while preventing annular dilation. In this study, we assessed the extent and nature of the flexibility of these rings in vivo, which has not been objectively demonstrated. METHODS Three-dimensional transesophageal echocardiography was used intraoperatively to acquire data regarding dynamic motion of mitral annuli and annuloplasty rings in 33 patients undergoing mitral repair (15 CG Future and 18 CE Physio II) and in 15 control patients. Data were analyzed to assess the dynamic changes in annular geometry after implantation of selectively flexible rings. RESULTS After annuloplasty, there was an immediate and significant decrease in annular displacement (p < 0.001) and annular displacement velocity (p < 0.01). Dynamic change in multiple variables including anteroposterior diameter (p < 0.001) and annular area (p < 0.001) was also significantly depressed. In comparison with normal mitral valves, partially flexible rings allowed limited dynamic motion: percentage changes in anteroposterior diameter (p < 0.001), anterolateral posteromedial diameter (p < 0.001), and total circumference (p < 0.001) were significantly lower. Compared with each other, the two rings resulted in similar changes in anterior annulus length (p = 0.93), posterior annular length (p = 0.82), and annular area (p = 0.31). CONCLUSIONS Mitral annular dynamics were uniformly depressed after implantation of these rings. Selective flexibility could not be demonstrated in vivo using echocardiographic data.
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Affiliation(s)
- Khurram Owais
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Han Kim
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kamal R Khabbaz
- Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Remco Bergman
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert C Gorman
- Division of Cardiovascular Surgery, Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Division of Cardiovascular Surgery, Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Philip E Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Mittnacht AJC, Sengupta PP. The dynamics of mitral valve function: lessons to be learned from three-dimensional echocardiography. J Cardiothorac Vasc Anesth 2014; 28:8-10. [PMID: 24440008 DOI: 10.1053/j.jvca.2013.11.008] [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: 11/13/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - Partho P Sengupta
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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11
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Warraich HJ, Matyal R, Bergman R, Hess PE, Khabbaz K, Manning WJ, Mahmood F. Impact of aortic valve replacement for aortic stenosis on dynamic mitral annular motion and geometry. Am J Cardiol 2013; 112:1445-9. [PMID: 23891429 DOI: 10.1016/j.amjcard.2013.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
The impact of aortic valve replacement (AVR) on the dynamic geometry and motion of the mitral annulus remains unknown. We analyzed the effects of AVR on the dynamic geometry and motion of the mitral annulus. We used 3-dimensional transesophageal echocardiography to analyze 39 consecutive patients undergoing elective surgical AVR for aortic stenosis. Intraoperative 3-dimensional transesophageal echocardiography was performed immediately before and after AVR. Volumetric data sets were analyzed using a software package capable of dynamically tracking the mitral annulus and leaflets during the entire systolic ejection phase. After AVR, there were significant decreases (p <0.01) in annular dimensions such as anteroposterior (3.5 ± 0.1 vs 3.2 ± 0.1 cm), anterolateral-posteromedial (3.7 ± 0.1 vs 3.5 ± 0.1 cm), and commissural diameters (3.7 ± 0.1 vs 3.3 ± 0.1 cm), as well as annular circumference (12.0 ± 0.30 vs 11.1 ± 0.2 cm) and 3-dimensional mitral annular area (mean 10.9 ± 0.6 vs 9.3 ± 0.3 cm(3)). Vertical mitral annular displacement was also reduced (6.2 ± 3.1 vs 4.3 ± 2.2 mm). Mitral annular nonplanarity angle (154 ± 1.5° vs 161 ± 1.6°) and aorto-mitral angle (133 ± 3.3° vs 142 ± 2.0°) were both increased after AVR, suggesting reduced nonplanar shape of the mitral annulus and reduced aorto-mitral flexion. In conclusion, these data demonstrate that mitral annular size is reduced immediately after AVR and that the dynamic motion of the mitral annulus is restricted. These findings may have important clinical implications for patients undergoing AVR with concurrent mitral regurgitation.
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Bartels K, Thiele RH, Phillips-Bute B, Glower DD, Swaminathan M, Kisslo J, Burkhard Mackensen G. Dynamic indices of mitral valve function using perioperative three-dimensional transesophageal echocardiography. J Cardiothorac Vasc Anesth 2013; 28:18-24. [PMID: 24011875 DOI: 10.1053/j.jvca.2013.03.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves. DESIGN Case-control observational clinical study. SETTING Tertiary care hospital. PARTICIPANTS Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease. MEASUREMENTS AND MAIN RESULTS Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices. CONCLUSIONS Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.
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Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Robert H Thiele
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Barbara Phillips-Bute
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Donald D Glower
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery
| | - Madhav Swaminathan
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Joseph Kisslo
- Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, Division of Cardiothoracic Anesthesiology, University of Washington, Seattle, WA.
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Mahmood F, Shakil O, Mahmood B, Chaudhry M, Matyal R, Khabbaz KR. Mitral annulus: an intraoperative echocardiographic perspective. J Cardiothorac Vasc Anesth 2013; 27:1355-63. [PMID: 23962462 DOI: 10.1053/j.jvca.2013.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Khabbaz KR, Mahmood F, Shakil O, Warraich HJ, Gorman JH, Gorman RC, Matyal R, Panzica P, Hess PE. Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation. Ann Thorac Surg 2012; 95:105-10. [PMID: 23103005 DOI: 10.1016/j.athoracsur.2012.08.078] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/24/2012] [Accepted: 08/27/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mitral valve (MV) annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV annular geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV annular geometry associated with FMR. METHODS Intraoperative 3D transesophageal echocardiographic data obtained from 34 patients with FMR and 15 controls undergoing cardiac operations were dynamically analyzed for differences in mitral annular geometry with TomTec 4D MV Assessment 2.0 software (TomTec Imaging Systems GmbH, Munich, Germany). RESULTS In patients with FMR, the mean mitral annular area (14.6 cm(2) versus 9.6 cm(2)), circumference (14.1 cm versus 11.4 cm), anteroposterior (4.0 cm versus 3.0 cm) and anterolateral-posteromedial (4.3 cm versus 3.6 cm) diameters, tenting volume (6.2 mm(3) versus 3.5 mm(3)) and nonplanarity angle (NPA) (154 degrees ± 15 versus 136 degrees ± 11) were greater at all points during systole compared with controls (p < 0.01). Vertical mitral annular displacement (5.8 mm versus 8.3 mm) was reduced in FMR compared with controls (p < 0.01). CONCLUSIONS There are significant differences in dynamic mitral annular geometry between patients with FMR and those without. We were able to analyze these changes in a clinically feasible fashion. Ready availability of this information has the potential to aid comprehensive quantification of mitral annular function and possibly assist in both clinical decision making and annuloplasty ring selection.
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Affiliation(s)
- Kamal R Khabbaz
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Shin JJ, Alfirevic A, Navia JL. Complications of percutaneous mitral balloon valvotomy: usefulness of real-time 3-dimensional technology. J Cardiothorac Vasc Anesth 2011; 27:546-8. [PMID: 22088750 DOI: 10.1053/j.jvca.2011.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Joyce J Shin
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH 44195, USA.
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