Preoperative morphological analysis by transesophageal echocardiography and predictive value of plasma landiolol concentration during systolic anterior motion mitral valve repair : a report of three cases

Abstract

We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring.

Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

“…The first important result of our study can be found in the basic geometry of the Coaptation Triangle and its two most important measurements, antero‐posterior diameter and coaptation depth, which resulted 31.4 mm and 7.4 mm, respectively. These values agree with literature findings, which report normal dimensions ranging from 26 to 32 mm for the antero‐posterior diameter and 5–9 mm for the coaptation depth . An interesting aspect of these dimensions is that they seem dependent on the geometry of the GCT.…”

“…The PC/AC ratio we obtained was 0.60, a number which is very close to the value of ϕ. Recent investigations on valve performance after conservative surgery concluded that an AC/PC ratio lower than 1.5 indicates a too anterior displacement of the coaptation point and significantly increases the risk for systolic anterior movement after mitral repair . Like the coaptation depth, the correct position of the coaptation point could be calculated geometrically.…”

“…An obvious but not less important result is that the PC/AC ratio is exactly 0.618, slightly more than 1.5, which is the limit under which some papers evidence an increased risk for SAM development after valve repair …”

“…The first important result of our study can be found in the basic geometry of the Coaptation Triangle and its two most important measurements, antero-posterior diameter and coaptation depth, ranging from 26 to 32 mm for the antero-posterior diameter and 5-9 mm for the coaptation depth. [28][29][30][31][32][33][34][35][36][37] An interesting aspect of these dimensions is that they seem dependent on the geometry of the GCT. In such a triangle, the anterior cord is ϕ times the anteroposterior diameter (AC = ϕAPD), the posterior cord is ϕ times the anterior cord (PC = ϕAC), and the coaptation depth is ϕ times the posterior cord (CD = ϕPC).…”

“…[45][46][47] An obvious but not less important result is that the PC/AC ratio is exactly 0.618, slightly more than 1.5, which is the limit under which some papers evidence an increased risk for SAM development after valve repair. 5,[28][29][30] Considering these results, we can also hypothesize the mechanical and clinical implications of a mitral geometry based on the Golden…”