Accurate measurement of mitral annular area by using single and biplane linear measurements: comparison of conventional methods with the three-dimensional planimetric method

Abstract

Conventional LAX/CC MAD can be recommended for MAA measurements in a diverse patient population. This method is applicable as an alternative to the 3D planimetric method, regardless of the mitral annulus shape.

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

“…AP/IC planes were found to be the most accurate method for measuring MAA without the influence of the annular shape. These results suggest that AP/IC plane measurements are the best alternative to the standard 3D planimetric MAA measurements [4]. In their study, Foster et al [6] showed that the correct anatomic imaging planes method of mitral annulus measurement correlated very well with cardiac computed tomography.…”

“…Three-dimensional (3D) echocardiography with planimetric method can be used to evaluate MAA precisely [22,23]. Hyodo et al [4] elucidated which methods have similar efficiency to that of the Figure 6. Mitral apparatus characteristics; *p < 0.05, compared with control group; §p < 0.05, compared with no mitral regurgitation group; MA -mitral annulus; APd -anteroposterior diameter; ICd -intercommissural diameter; AML -anterior mitral leaflet; PML -posterior mitral leaflet; MAA -mitral annular area; TA -tenting area; PMPM -posteromedial papillary muscle; IPMD -interpapillary muscle distance; NMR -no mitral regurgitation; IMR -ischaemic mitral regurgitation 3D planimetric method for MAA measurement.…”

“…Mitral annulus area (MAA) was calculated in end-diastole and end-systole using the formula of an ellipse: MAA = p × r1 × r2/4 -where r1 and r2 were AP and IC mitral annular dimensions, respectively [4]. Tenting height was measured as the distance between the coaptation point of the mitral leaflets and the annular plane (reflected by the line connecting the contralateral leaflet insertion points to the annulus) of the mitral valve in systole from the apical long-axis (three-chamber) view - Figure 2 (black line).…”

“…The normal geometry of the mitral valve apparatus becomes distorted, resulting in incomplete leaflet closure and regurgitation [3]. Extensive research has been performed to analyse the distortion of mitral apparatus (MA) in IMR and myocardial infarction (MI) using different imaging modalities [4][5][6]. Recent computerised tomography-based studies have shown that the conventionally used two-dimensional (2D) echocardiographic imaging planes of mitral annulus and other structures using the four-chamber view to represent the long mitral axis and parasternal long-axis views for short mitral axis measurements are anatomically incorrect [6].…”

Preoperative Evaluation Before MitraClip ® : Present and Future Perspective

“…Precise knowledge of the MV anatomy during the cardiac cycle, including mitral annulus changes and mitral leaflet curvature and stress, is necessary in order to allow accurate characterization of the etiology of MV prolapse and therefore to further enhance MV repair surgery or MitraClip therapy and to define objective criteria for assessing postsurgery/ procedure follow-up [34]. The measurement of the mitral annulus area by 3D echocardiography is accepted as an accurate method and a comparator for other methods [35]. Schmidt et al have recently demonstrated that, in FMR, percutaneous treatment with the MitraClip device can produce immediate reductions both in mitral annulus size (anterior-posterior MV diameter) and tenting [36].…”