Regional annular geometry in patients with mitral regurgitation: implications for annuloplasty ring selection.
Publication/Presentation Date
1-1-2014
Abstract
BACKGROUND: The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional annular geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral annular shape is markedly distorted in patients with diseased valves.
METHODS: Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six annular points were defined to generate a 3-dimensional model of the annulus. Regional annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images.
RESULTS: Annular geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group.
CONCLUSIONS: Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
Volume
97
Issue
1
First Page
64
Last Page
70
ISSN
1552-6259
Published In/Presented At
Jassar, A. S., Vergnat, M., Jackson, B. M., McGarvey, J. R., Cheung, A. T., Ferrari, G., Woo, Y. J., Acker, M. A., Gorman, R. C., & Gorman, J. H., 3rd (2014). Regional annular geometry in patients with mitral regurgitation: implications for annuloplasty ring selection. The Annals of thoracic surgery, 97(1), 64–70. https://doi.org/10.1016/j.athoracsur.2013.07.048
Disciplines
Medicine and Health Sciences
PubMedID
24070698
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article