J Cardiovasc Ultrasound.  2017 Jun;25(2):47-56. 10.4250/jcu.2017.25.2.47.

Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography

• Cho EJ
• Park SJ
• Lee GY
• Kim EK
• Chang SA
• Choi JO
• Lee SC
• Park SW
• Park PW

• KMID: 2385075
• DOI: http://doi.org/10.4250/jcu.2017.25.2.47

Abstract

BACKGROUND
The extent of mitral annular (MA) remodeling and dysfunction is correlated with the severity of mitral regurgitation (MR) as well as left atrial (LA) and left ventricular (LV) dilation. MA dysfunction may be a useful prognostic factor for operative timing and MR recurrence after successful mitral valve (MV) repair. The aim of this study was to evaluate additive prognostic factors of MA non-planarity using real-time 3D transesophageal echocardiography (RT3D-TEE) analysis in patients with chronic severe MR and preserved LV systolic function.
METHODS
Forty-seven patients with chronic severe MR and preserved LV systolic function scheduled for MV repair were prospectively enrolled. Echocardiographic studies were performed before surgery and postoperatively within 2 weeks and at least 6 months after surgery. RT3D-TEE was performed before the operation and immediately post-operative.
RESULTS
Mean age was 55.4 ± 15.1 years and 24 were male. Annulus height/body surface area (BSA) obtained via RT3D-TEE was correlated with the degree of postoperative LA remodeling. Patients were divided into two groups by average baseline annulus height/BSA. Patients with normal annular height had a smaller postoperative LV end-diastolic dimension, LV end-systolic dimension and LA volume index than patients with decreased annular height. Preoperative annulus height/BSA values strongly predicted postoperative LA remodeling.
CONCLUSION
MA height may be a useful prognostic factor for determining the timing of surgery in patients with chronic primary MR. Annulus height/BSA assessed via RT3D-TEE may provide additional information predictive of postoperative LA remodeling after successful MV repair.

Keyword

Mitral regurgitation; Mitral annular; Annulus height; Real-time 3D transesophageal echocardiography

MeSH Terms

Echocardiography
Echocardiography, Transesophageal*
Humans
Male
Mitral Valve
Mitral Valve Insufficiency*
Prospective Studies
Recurrence
Stroke Volume*

Figure

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  Fig. 1 Screenshot of the Mitral-Valve-Quantification software showing the volume-rendered 3D data set (bottom right) as well as the three cut planes used to improve the visualization of the mitral valve. Ao: aorta, A: anterior, P: posterior, AL: anterolateral, PM: posteromedial.

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  Fig. 2 Three-dimensional reconstruction of the mitral valve, from which several parameters were automatically calculated. From top to bottom, left to right: anterolateral to posteromedial diameter of annulus; anterior to posterior diameter of annulus; mitral annular height, defined as the height of the bounding box of the mitral valve in the atrial-ventricular direction; maximal prolapse height; maximal tenting height; area of annulus in projection plane; exposed area of anterior leaflet; exposed area of posterior leaflet; perimeter of annulus; aortic orifice to mitral plane angle; length of coaptation in projection plane; exposed length of A2; exposed length of P2; volume of leaflet prolapse; volume of the leaflets tent; angle of anterior leaflet; nonplanar angle of leaflets; angle of posterior leaflet; annular height to commissural width ratio. Ao: aorta, A: anterior, P: posterior, AL: anterolateral, PM: posteromedial.

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  Fig. 3 Scatter diagram with Pearson's correlation of the annular height/BSA by RT3D-TEE and the degree of LAVI decrease between echocardiography obtained at baseline and at least 6 months postoperatively. LAVI: left atrial volume index, BSA: body surface area, RT3D-TEE: real-time 3D transesophageal echocardiography.

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