Dynamic three-dimensional imaging of the mitral valve and left ventricle by rapid sonomicrometry array localization

Gorman, Joseph H.; Gupta, Krishanu B.; Streicher, James T.; Gorman, Robert C.; Jackson, Benjamin M.; Ratcliffe, Mark B.; Bogen, Daniel K.; Edmunds, L. Henry

doi:10.1016/s0022-5223(96)70056-9

Cited by 168 publications

(113 citation statements)

References 20 publications

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“…Based on the sonomicrometry data, Multi Dimensional Scaling techniques (MDS, CardioSOFT and SonoXYZ; Sonometrics Corp) 18 were used to assess the relative difference in mitral annulus geometry and AHCWR between mid-systole and -diastole before and after ring implantation. A least-square fit plane was constructed with data from the annulus crystals to define the saddle height.…”

Section: Discussionmentioning

confidence: 99%

Saddle-Shaped Mitral Valve Annuloplasty Rings Experience Lower Forces Compared With Flat Rings

Jensen

Jensen²,

Smerup³

et al. 2008

Circulation

100

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Background-New insight into the 3D dynamic behavior of the mitral valve has prompted a reevaluation of annuloplasty ring designs. Force balance analysis indicates correlation between annulus forces and stresses in leaflets and chords. Improving this stress distribution can intuitively enhance the durability of mitral valve repair. We tested the hypothesis that saddle-shaped annuloplasty rings have superior uniform systolic force distribution compared with a nonuniform force distribution in flat annuloplasty rings. Methods and Results-Sixteen 80-kg pigs had a flat (nϭ8) or saddle-shaped (nϭ8) mitral annuloplasty ring implanted. Mitral annulus 3D dynamic geometry was obtained with sonomicrometry before ring insertion. Strain gauges mounted on dedicated D-shaped rigid flat and saddle-shaped annuloplasty rings provided the intraoperative force distribution perpendicular to the annular plane. Average systolic annular height to commissural width ratio before ring implantation was 14.0%Ϯ1.6%. After flat and saddle shaped ring implantation, the annulus was fixed in the diastolic (9.0%Ϯ1.0%) and systolic (14.3%Ϯ1.3%) configuration, respectively (PϽ0.01). Force accumulation was seen from the anterior (0.72NϮ0.14N) and commissural annular segments (average 1.38NϮ0.27N) of the flat rings. In these segments, the difference between the 2 types of rings was statistically significant (PϽ0.05). The saddle-shaped annuloplasty rings did not experience forces statistically significantly larger than zero in any annular segments. Conclusions-Saddle-shaped annuloplasty rings provide superior uniform annular force distribution compared to flat rings and appear to represent a configuration that minimizes out-of-plane forces that could potentially be transmitted to leaflets and chords.

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Section: Discussionmentioning

confidence: 99%

Saddle-Shaped Mitral Valve Annuloplasty Rings Experience Lower Forces Compared With Flat Rings

Jensen

Jensen²,

Smerup³

et al. 2008

Circulation

100

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“…(9) is satisfied in the linear boundary conditions of the biharmonic PDE [Eq. (10)], the inequality constraints are incorporated as soft penalty terms in the objective function. The reason for enforcing the inequality constraints in this manner is that conjugate gradient descent is used for optimization.…”

Section: Appendix: Bayesian Objective Function For Deformable Medial mentioning

confidence: 99%

Development of a semi-automated method for mitral valve modeling with medial axis representation using 3D ultrasound

Pouch¹,

Yushkevich²,

Jackson³

et al. 2012

Med. Phys.

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Purpose: Precise 3D modeling of the mitral valve has the potential to improve our understanding of valve morphology, particularly in the setting of mitral regurgitation (MR). Toward this goal, the authors have developed a user-initialized algorithm for reconstructing valve geometry from transesophageal 3D ultrasound (3D US) image data. Methods: Semi-automated image analysis was performed on transesophageal 3D US images obtained from 14 subjects with MR ranging from trace to severe. Image analysis of the mitral valve at midsystole had two stages: user-initialized segmentation and 3D deformable modeling with continuous medial representation (cm-rep). Semi-automated segmentation began with useridentification of valve location in 2D projection images generated from 3D US data. The mitral leaflets were then automatically segmented in 3D using the level set method. Second, a bileaflet deformable medial model was fitted to the binary valve segmentation by Bayesian optimization. The resulting cm-rep provided a visual reconstruction of the mitral valve, from which localized measurements of valve morphology were automatically derived. The features extracted from the fitted cm-rep included annular area, annular circumference, annular height, intercommissural width, septolateral length, total tenting volume, and percent anterior tenting volume. These measurements were compared to those obtained by expert manual tracing. Regurgitant orifice area (ROA) measurements were compared to qualitative assessments of MR severity. The accuracy of valve shape representation with cm-rep was evaluated in terms of the Dice overlap between the fitted cm-rep and its target segmentation. Results: The morphological features and anatomic ROA derived from semi-automated image analysis were consistent with manual tracing of 3D US image data and with qualitative assessments of MR severity made on clinical radiology. The fitted cm-reps accurately captured valve shape and demonstrated patient-specific differences in valve morphology among subjects with varying degrees of MR severity. Minimal variation in the Dice overlap and morphological measurements was observed when different cm-rep templates were used to initialize model fitting. Conclusions: This study demonstrates the use of deformable medial modeling for semi-automated 3D reconstruction of mitral valve geometry using transesophageal 3D US. The proposed algorithm provides a parametric geometrical representation of the mitral leaflets, which can be used to evaluate valve morphology in clinical ultrasound images.

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“…Similarly, Vesely et al interpreted aortic root dilation prior to valve opening as secondary to passive hemodynamic recoil of the aortic root (Hansen et al, 1995). Three-dimensional (3D) digital sonomicrometry, characterized by a high rate of data acquisition (200 to 800 Hz), offers opportunity for a precise time-related study of the aortic root and valve dynamics within each phase of the normal cardiac cycle (Gorman et al, 1996;Hansen et al, 1995;Pang et al, 2000). Using this technique we intended to precise the mechanism of aortic root expansion and the shape of the aortic valve orifice at maximum opening on an ovine model.…”

Section: The Ascending Aorta: a Dynamic Structurementioning

confidence: 99%

An Expansible Aortic Ring for a Standardized and Physiological Approach of Aortic Valve Repair

Lansac¹,

Centa²,

Escande³

et al. 2011

Aortic Valve Surgery

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Dynamic three-dimensional imaging of the mitral valve and left ventricle by rapid sonomicrometry array localization

Cited by 168 publications

References 20 publications

Saddle-Shaped Mitral Valve Annuloplasty Rings Experience Lower Forces Compared With Flat Rings

Saddle-Shaped Mitral Valve Annuloplasty Rings Experience Lower Forces Compared With Flat Rings

Development of a semi-automated method for mitral valve modeling with medial axis representation using 3D ultrasound

An Expansible Aortic Ring for a Standardized and Physiological Approach of Aortic Valve Repair

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