Three-Dimensional Assessment of Left Ventricular Geometry and Annular Dilatation Provides New Mechanistic Insights into the Surgical Correction of Ischemic Mitral Regurgitation

Abstract

These findings suggest that ischemic mitral regurgitation was mostly associated with a global left ventricular enlargement, in which annulus dilatation and its reduced contraction play a significant role.

RT-3D TEE: Characteristics of Mitral Annulus Using Mitral Valve Quantification (MVQ) Program

“…Mitral annulus is a dynamic structure which changes its shape during normal physiologic as well as pathologic process. [7][8][9][10][11][12][13] Furthermore, mitral annulus is not a planar structure but it is saddle shaped. [9][10][11][12][13] Although this fact is generally accepted, the vertical dimension of mitral annulus cannot be precisely measured using 2D imaging.…”

“…In chronic regurgitation the left ventricle dilates because of volume overload and the ventricular dilatation causes dilatation of mitral annulus as well. 8 The mechanism of mitral annulus remodeling in ischemic heart disease and mitral valve prolapse/flail are similar as both conditions lead to dilation and increased sphericity. Tension affecting the mitral annulus is oriented mainly horizontally.…”

On the calculation of principle curvatures of the left-ventricular surfaces

“…For instance, despite successful acute treatment of coronary events, myocardial infarction and chronic ischemic heart disease often evolve to heart failure through a process of cardiac remodeling [2]. Also valvular pathologies like mitral regurgitation [3], [4], which mean a significant hemodynamic burden on the left ventricle (LV), evolve in the long term to heart failure through a process of adverse ventricular dilatation. Often this is associated with ventricular dyssynchrony.…”

“…This global remodeling parameter does not take into account shape changes of the ventricle. Therefore, the global shape of the LV is often characterized by introducing a sphericity index which is the ratio of the short over the long axis of the LV [3]. In the process of remodeling, regional shape changes can precede the global shape change and dilatation.…”

Valor de la insuficiencia mitral previa a un primer infarto de miocardio, en el pronóstico clínico y la hemodinámica ventricular

“…En los últimos años en el mundo de la ecocardiografía se han realizado importantes avances técnicos, como la introducción del Doppler tisular, Speckle -tracking o la ecocardiografía tridimensional (transtorácia y transesofágica) en tiempo real (225,235,238,239,240,241) , con herramientas de análisis de datos muy sofisticadas (Xcelera®) que auguran una cada vez mejor evaluación de esta enfermedad.…”