Document Detail


Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection.
MedLine Citation:
PMID:  22965981     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Proponents of flexible annuloplasty rings have hypothesized that such devices maintain annular dynamics. This hypothesis is based on the supposition that annular motion is relatively normal in patients undergoing mitral valve repair. We hypothesized that mitral annular dynamics are impaired in ischemic mitral regurgitation and myxomatous mitral regurgitation.
METHODS AND RESULTS: A Philips iE33 echocardiographic module and X7-2t probe were used to acquire full-volume real-time 3-dimensional transesophageal echocardiography loops in 11 normal subjects, 11 patients with ischemic mitral regurgitation and 11 patients with myxomatous mitral regurgitation. Image analysis was performed using Tomtec Image Arena, 4D-MV Assessment, 2.1 (Munich, Germany). A midsystolic frame was selected for the initiation of annular tracking using the semiautomated program. Continuous parameters were normalized in time to provide for uniform systolic and diastolic periods. Both ischemic mitral regurgitation (9.98 ± 155 cm(2)) and myxomatous mitral regurgitation annuli (13.29 ± 3.05 cm(2)) were larger in area than normal annuli (7.95 ± 1.40 cm(2)) at midsystole. In general, ischemic mitral regurgitation annuli were less dynamic than controls. In myxomatous mitral regurgitation, annular dynamics were also markedly abnormal with the mitral annulus dilating rapidly in early systole in response to rising ventricular pressure.
CONCLUSIONS: In both ischemic mitral regurgitation and myxomatous mitral regurgitation, annular dynamics and anatomy are abnormal. Flexible annuloplasty devices used in mitral valve repair are, therefore, unlikely to result in either normal annular dynamics or normal anatomy.
Authors:
Melissa M Levack; Arminder S Jassar; Eric K Shang; Mathieu Vergnat; Y Joseph Woo; Michael A Acker; Benjamin M Jackson; Joseph H Gorman; Robert C Gorman
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-11     Completed Date:  2012-11-27     Revised Date:  2013-09-16    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S183-8     Citation Subset:  AIM; IM    
Affiliation:
Gorman Cardiovascular Research Group, Glenolden, PA 19036, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Echocardiography, Three-Dimensional* / instrumentation
Female
Humans
Male
Middle Aged
Mitral Valve / physiopathology,  ultrasonography*
Mitral Valve Annuloplasty* / statistics & numerical data
Mitral Valve Insufficiency / physiopathology,  surgery,  ultrasonography
Mitral Valve Prolapse / physiopathology,  surgery,  ultrasonography
Motion
Myocardial Ischemia / physiopathology,  surgery,  ultrasonography
Patient Selection*
Preoperative Care
Grant Support
ID/Acronym/Agency:
HL103723/HL/NHLBI NIH HHS; HL63954/HL/NHLBI NIH HHS; HL73021/HL/NHLBI NIH HHS; R01 HL063954/HL/NHLBI NIH HHS; R01 HL073021/HL/NHLBI NIH HHS; R01 HL103723/HL/NHLBI NIH HHS
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