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Palmisano A, Nicoletti V, Colantoni C, Monti CB, Pannone L, Vignale D, Darvizeh F, Agricola E, Schaffino S, De Cobelli F, Esposito A. Dynamic changes of mitral valve annulus geometry at preprocedural CT: relationship with functional classes of regurgitation. Eur Radiol Exp 2021; 5:34. [PMID: 34386843 PMCID: PMC8360976 DOI: 10.1186/s41747-021-00231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated mitral valve annular geometry changes during the cardiac cycle in patients with severe mitral regurgitation (MR) who underwent cardiac computed tomography angiography (CCTA) prior to percutaneous mitral valve replacement or annuloplasty. METHODS Fifty-one patients with severe MR and high surgical risk (Carpentier classification: 3 type I, 16 type II, 16 type IIIa, 16 type IIIb) underwent multiphase electrocardiographically gated (0-90%) CCTA, using a second generation dual-source CT scanner, as pre-procedural planning. Twenty-one patients without MR served as controls. The mitral valve annulus was segmented every 10% step of the R-R interval, according to the D-shaped segmentation model, and differences among groups were analysed by t-test or ANOVA. RESULTS Mitral annular area and diameters were larger in MR patients compared to controls, particularly in type II. Mitral annular area varied in MR patients throughout the cardiac cycle (mean ± standard deviation of maximum and minimum area 15.6 ± 3.9 cm2 versus 13.0 ± 3.5 cm2, respectively; p = 0.001), with greater difference between annular areas versus controls (2.59 ± 1.61 cm2 and 1.98 ± 0.6 cm2, p < 0.001). The largest dimension was found in systolic phases (20-40%) in most of MR patients (n = 27, 53%), independent of Carpentier type (I: n = 1, 33%; II: n = 10, 63%; IIIa: n = 8, 50%; IIIb: n = 8, 50%), and in protodiastolic phases (n = 14, 67%) for the control group. CONCLUSIONS In severe MR, mitral annular area varied significantly throughout the cardiac cycle, with a tendency towards larger dimensions in systole.
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Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina Colantoni
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Luigi Pannone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Echocardiography Unit, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fatemeh Darvizeh
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Eustachio Agricola
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Echocardiography Unit, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Schaffino
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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