J Korean Med Sci.  2006 Apr;21(2):217-223. 10.3346/jkms.2006.21.2.217.

Acute Geometric Changes of the Mitral Annulus after Coronary Occlusion: A Real-Time 3D Echocardiographic Study

• Kwan J
• Yeom BW
• Jones M
• Qin JX
• Zetts AD
• Thomas JD
• Shiota T

• KMID: 1781825
• DOI: http://doi.org/10.3346/jkms.2006.21.2.217

Abstract

We performed real-time 3D echocardiography in sixteen sheep to compare acute geometric changes in the mitral annulus after left anterior descending coronary artery (LAD, n=8) ligation and those after left circumflex coronary artery (LCX, n=8) ligation. The mitral regurgitation (MR) was quantified by regurgitant volume (RV) using the proximal isovelocity surface area method. The mitral annulus was reconstructed through the hinge points of the annulus traced on 9 rotational apical planes (angle increment=20 degrees). Mitral annular area (MAA) and the ratio of antero-posterior (AP) to commissure-commissure (CC) dimension of the annulus were calculated. Non-planar angle (NPA) representing non-planarity of the annulus was measured. After LCX occlusion, there were significant increases of the MAA during both early and late systole (p<0.01) with significant MR (RV: 30+/-14 mL), while there was neither a significant increase of MAA, nor a significant MR (RV: 4+/-5 mL) after LAD occlusion. AP/CC ratio (p<0.01) and NPA (p<0.01) also significantly increased after LCX occlusion during both early and late systole. The mitral annulus was significantly enlarged in the antero-posterior direction with significant decrease of non-planarity compared to LAD occlusion immediately after LCX occlusion.

Keyword

Mitral Valve; Mitral Annulus; Echocardiography; Coronary Disease

MeSH Terms

Sheep
Mitral Valve/*pathology/*ultrasonography
Ligation
Image Processing, Computer-Assisted
Echocardiography, Three-Dimensional
Coronary Vessels/*pathology/*ultrasonography
Coronary Arteriosclerosis/pathology/ultrasonography
Animals

Figure

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  Fig. 1 Nine rotational apical planes were used to trace 18 hinge points (white dots) of the mitral annulus (A). 3D shape of the mitral annulus reconstructed from the 18 hinge points (B). Projected view of 3D reconstructed annulus (C).

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  Fig. 2 Volumetric image showing how the non-planar angle (NPA) of the annulus was measured. Using 3D computer software (TomTec), we measured the angle between two vectors from two hinge points of the annulus (white dots) in the antero-posterior (AP) plane to the center of the axis connecting two commssures (white dot) in the commissure-commissure (CC) plane. AML, anterior mitral leaflet; MV, mitral valve; PML, posterior mitral leaflet.

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  Fig. 3 Change of the non-planar angle (NPA) of the mitral annulus after coronary occlusion.

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  Fig. 4 Graphs showing significant correlations (p<0.01) of percent change (Δ) of the non-planar angle (NPA) with that of the mitral annular area (MAA) and the antero-posterior dimension (AP).

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  Fig. 5 Graphs showing weak but statistically insignificant correlations (p>0.05) of percent change (Δ) of the mitral annular area (MAA) and the non-planar angle (NPA) with regurgitant volume (RV).

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  Fig. 6 Apical movement of the posterior annulus (arrow) before and after LCX occlusion. AP, antero-posterior dimension; NPA, non-planar angle. Note the smaller movement of the posterior annulus after LCX occlusion than before the occlusion.

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