A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty☆

Simone, Raffaele De; Wolf, Ivo; Mottl-Link, Sibylle; Hoda, Raschid; Mikhail, Bassem; Sack, FU; Meinzer, Hans Peter; Hagl, S.

doi:10.1016/j.ejcts.2005.12.034

Cited by 37 publications

(19 citation statements)

References 22 publications

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“…The mitral annulus has been clarified to be a non-planar "saddle" shape with lower commissural sides, which is essential for the mitral valve (MV) to reduce the pressure on valve leaflets in systole. 22,23) When significant MR occurs, the MA dilates and tends to be flat, 6,24,25) exacerbating MR. Our results showed that the MA area and anteroposterior diameter significantly increased as the regurgitation progressed. The P value of the anteroposterior diameter between the mild MR group and controls (P = 0.052) was quite close to the level of statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Zhang

Qiu

et al. 2015

Int. Heart J.

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SummaryTo quantitatively assess the geometric changes in mitral valve apparatus in mitral regurgitation (MR) by dualsource computed tomography (DSCT) and to analyze its impact on MR.The study subjects consisted of 20 controls, 20 patients with mild MR, and 30 patients with moderate to severe MR, all of whom underwent DSCT. The geometric parameters of the mitral valve were measured by CT and compared among the 3 groups. The correlations between DSCT measurements and MR severity were also analyzed.As regurgitation worsened, our results showed progressive enlargements of the mitral annular area, anteroposterior diameter, and mitral valve tenting area at the central level. Moreover, a higher mitral valve sphericity index and longer distance between the heads of the papillary muscles reflected a more outward displacement of the papillary muscles. The mitral annular area and tenting area at the central level had strong correlations with regurgitation severity.DSCT is available to quantitatively assess mitral valve morphology and provide additional information regarding its geometry. The mitral annular area and tenting area at the central level were the strongest determinants of MR severity. Regardless of whether the regurgitation is caused by a primary anatomical abnormality of the mitral valve 2) or secondary to left ventricular dysfunction, 3,4) moderate to severe MR is associated with a lower survival rate. The progression of significant MR may result in pulmonary hypertension and heart failure.The mitral valve apparatus is a complex 3-dimensional structure consisting of the mitral annulus (MA), leaflet, chordae tendinae, papillary muscles (PMs), and the attached left ventricular wall. Every component works in a coordinated, precise manner to prevent blood flowing back into the left atrium during cardiac systole. A comprehensive, accurate assessment of the mitral apparatus is very important for determining the optimal treatment plan, deciding the timing of surgical intervention, and determining the prognosis. In recent years, there have been several studies on mitral valve structure. [5][6][7][8] However, most studies focused on one part of the mitral apparatus. Due to the complexity and delicacy of the mitral valve, assessing the apparatus quantitatively and comprehensively remains a considerable challenge for physicians.Coronary computed tomography (CT) angiography is currently used as an invasive tool to evaluate the coronary anatomy and exclude significant ischemic heart disease in patients referred for valvular surgery with high sensitivity and specificity.9-12) Recent advances in multi-detector CT (MDCT)/ dual-source CT (DSCT) have provided a better understanding and assessment of the heart valves, [13][14][15][16][17][18] with high spatial resolution, excellent image quality, and comprehensive cardiac data. Therefore, this study aimed to quantitatively assess the anatomy and geometry of the mitral valve apparatus using ECG-gated 64-slice DSCT.

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Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Zhang

Qiu

et al. 2015

Int. Heart J.

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“…MA assessment is of great importance for the diagnosis and treatment of mitral valve disease. MA dilatation is one of the main mechanisms for development of mitral regurgitation and selection of the optimal individual therapy for mitral regurgitation depends on MA size and function [4,5]. This has been studied in both animals and humans using echocardiography, sonomicrometry and magnetic resonance imaging (MRI) [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging

Anwar

Soliman

Cate³

et al. 2006

Int J Cardiovasc Imaging

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“…The mitral annulus after MI undergoes a number of structural changes in IMR, becoming larger and flatter [5,20,21]. An increase in size causes the effacement of the mitral leaflets compromising coaptation length.…”

Section: Discussionmentioning

confidence: 99%

Assessment of mitral apparatus in patients with acute inferoposterior myocardial infarction and ischaemic mitral regurgitation with two-dimensional echocardiography from anatomically correct imaging planes

2017

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A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty☆

Cited by 37 publications

References 22 publications

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation

True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging

Assessment of mitral apparatus in patients with acute inferoposterior myocardial infarction and ischaemic mitral regurgitation with two-dimensional echocardiography from anatomically correct imaging planes

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