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Iliakis P, Dimitriadis K, Pyrpyris N, Beneki E, Theofilis P, Tsioufis P, Kamperidis V, Aznaouridis K, Aggeli K, Tsioufis K. Atrial Functional Mitral Regurgitation: From Diagnosis to Current Interventional Therapies. J Clin Med 2024; 13:5035. [PMID: 39274249 PMCID: PMC11396481 DOI: 10.3390/jcm13175035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Mitral regurgitation (MR) is one of the most common valvular pathologies worldwide, contributing to the morbidity and mortality of several cardiovascular pathologies, including heart failure (HF). Novel transcatheter treatment for MR has given the opportunity for a safe and feasible alternative, to surgery, in order to repair the valve and improve patient outcomes. However, after the results of early transcatheter edge-to-edge repair (TEER) trials, it has become evident that subcategorizing the mitral regurgitation etiology and the left ventricular function, in patients due to undergo TEER, is of the essence, in order to predict responsiveness to treatment and select the most appropriate patient phenotype. Thus, a novel MR phenotype, atrial functional MR (AFMR), has been recently recognized as a distinct pathophysiological entity, where the etiology of the regurgitation is secondary to annular dilatation, in a diseased left atrium, with preserved left ventricular function. Recent studies have evaluated and compared the outcomes of TEER in AFMR with ventricular functional MR (VFMR), with the results favoring the AFMR. In specific, TEER in this patient substrate has better echocardiographic and long-term outcomes. Thus, our review will provide a comprehensive pathogenesis and mechanistic overview of AFMR, insights into the echocardiographic approach of such patients and pre-procedural planning, discuss the most recent clinical trials and their implications for future treatment directions, as well as highlight future frontiers of research in the setting of TEER and transcatheter mitral valve replacement (TMVR) in AFMR patients.
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Affiliation(s)
- Panagiotis Iliakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Panagiotis Theofilis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Vasileios Kamperidis
- First Cardiology Department, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 544 53 Thessaloniki, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
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Persson RM, Aguilera HMD, Kvitting JE, Grong K, Prot VE, Salminen P, Svenheim B, Leiknes A, Stangeland L, Haaverstad R, Urheim S. Mitral annular dynamics are influenced by left ventricular load and contractility in an acute animal model. Physiol Rep 2023; 11:e15665. [PMID: 37062589 PMCID: PMC10106308 DOI: 10.14814/phy2.15665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
The purpose of this study was to investigate the effects of loading conditions and left ventricular (LV) contractility on mitral annular dynamics. In 10 anesthetized pigs, eight piezoelectric transducers were implanted equidistantly around the mitral annulus. High-fidelity catheters measured left ventricular pressures and the slope of the end-systolic pressure-volume relationship (Ees ) determined LV contractility. Adjustments of pre- and afterload were done by constriction of the inferior caval vein and occlusion of the descending aorta. Mitral annulus area indexed to body surface area (MAAi ), annular circularity index (ACI), and non-planarity angle (NPA) were calculated by computational analysis. MAAi was more dynamic in response to loading interventions than ACI and NPA. However, MAAi maximal cyclical reduction (-Δr) and average deformational velocity (-v ¯ $$ \overline{v} $$ ) did not change accordingly (p = 0.31 and p = 0.22). Reduced Ees was associated to attenuation in MAAi -Δr and MAAi -v ¯ $$ \overline{v} $$ (r2 = 0.744; p = 0.001 and r2 = 0.467; p = 0.029). In conclusion, increased cardiac load and reduced LV contractility may cause deterioration of mitral annular dynamics, likely impairing coaptation and increasing susceptibility to valvular incompetence.
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Affiliation(s)
- Robert Matongo Persson
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
- Department of Clinical Science, Faculty of MedicineUniversity of BergenBergenNorway
| | - Hans Martin Dahl Aguilera
- Department of Structural Engineering, Faculty of Engineering ScienceThe Norwegian University of Science and TechnologyTrondheimNorway
| | - John‐Peder Escobar Kvitting
- Department of Cardiothoracic SurgeryOslo University Hospital, RikshospitaletOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Ketil Grong
- Department of Clinical Science, Faculty of MedicineUniversity of BergenBergenNorway
| | - Victorien Emile Prot
- Department of Structural Engineering, Faculty of Engineering ScienceThe Norwegian University of Science and TechnologyTrondheimNorway
| | | | - Bård Svenheim
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Anita Leiknes
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Lodve Stangeland
- Department of Clinical Science, Faculty of MedicineUniversity of BergenBergenNorway
| | - Rune Haaverstad
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
- Department of Clinical Science, Faculty of MedicineUniversity of BergenBergenNorway
| | - Stig Urheim
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
- Department of Clinical Science, Faculty of MedicineUniversity of BergenBergenNorway
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Frishman S, Kight A, Pirozzi I, Maddineni S, Imbrie-Moore AM, Karachiwalla Z, Paulsen MJ, Kaiser AD, Woo YJ, Cutkosky MR. DynaRing: A Patient-Specific Mitral Annuloplasty Ring With Selective Stiffness Segments. J Med Device 2022; 16:031009. [PMID: 35646225 PMCID: PMC9125864 DOI: 10.1115/1.4054445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2022] [Indexed: 09/03/2023] Open
Abstract
Annuloplasty ring choice and design are critical to the long-term efficacy of mitral valve (MV) repair. DynaRing is a selectively compliant annuloplasty ring composed of varying stiffness elastomer segments, a shape-set nitinol core, and a cross diameter filament. The ring provides sufficient stiffness to stabilize a diseased annulus while allowing physiological annular dynamics. Moreover, adjusting elastomer properties provides a mechanism for effectively tuning key MV metrics to specific patients. We evaluate the ring embedded in porcine valves with an ex-vivo left heart simulator and perform a 150 million cycle fatigue test via a custom oscillatory system. We present a patient-specific design approach for determining ring parameters using a finite element model optimization and patient MRI data. Ex-vivo experiment results demonstrate that motion of DynaRing closely matches literature values for healthy annuli. Findings from the patient-specific optimization establish DynaRing's ability to adjust the anterior-posterior and intercommissural diameters and saddle height by up to 8.8%, 5.6%, 19.8%, respectively, and match a wide range of patient data.
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Affiliation(s)
- Samuel Frishman
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
| | - Ali Kight
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | - Ileana Pirozzi
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | | | | | | | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | | | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | - Mark R. Cutkosky
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
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Wesselowski S, Saunders A, Werre S, Gordon S. Echocardiographic measurement of the mitral valve in normal Cavalier King Charles spaniels: repeatability, optimal future study methods, and preliminary reference intervals. J Vet Cardiol 2022; 43:81-92. [DOI: 10.1016/j.jvc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
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Comparison of mitral annular displacement and global longitudinal strain imaging for predicting significant coronary atherosclerotic disease in patients of chronic stable angina pectoris. Int J Cardiovasc Imaging 2020; 37:861-870. [PMID: 33078275 DOI: 10.1007/s10554-020-02058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Myocardial strain by two-dimensional speckle-tracking echocardiography (2D-STE) is a validated clinical index of myocardial deformation, for predicting CAD in patients with chronic stable angina pectoris (CSAP) with preserved ejection fraction (EF). However, it is complex, imaging dependant with intra and intervendor variability. The mitral annulus displacement (MAD) has been correlated to left ventricular (LV) longitudinal deformation and may be interchanged with strain imaging. This cross-sectional study was conducted on patients with suspected CSAP (n = 146) and preserved LVEF without wall motion abnormalities. We excluded patients with prior heart disease, ACS, arrhythmia, heart failure or poor imaging. GLS, Average MAD and normalized MAD were calculated using 2D-STE by automated function imaging. CAG was gold standard. MAD had significantly lesser dropout due to suboptimal imaging. Receiver operating characteristic (ROC) analysis showed that GLS had significantly better area under curve (AUC) compared to Normalised MAD and Average MAD (P = 0.035) in predicting significant CAD in patients of CSAP. The optimal cut-off of GLS, normalized MAD and Average MAD were ≥ - 20.67% (sensitivity 94.2%, specificity 86.7%), ≤ 15.22% (sensitivity 90.7%, specificity 80%) and ≤ 11.18 mm (sensitivity 83.7%, specificity 71.1%) respectively. GLS showed strong correlation with Normalised MAD (R = 0.669, P < 0.001) and good correlation to Average MAD (R 0.572, P < 0.001). Absolute GLS and Normalised MAD showed significant inverse correlation to SYNTAX score. GLS is a more accurate measure for predicting presence and severity of CAD then MAD however latter is a reliable simpler, robust, and expeditious tool with lesser dropouts. It can be at least of complementary value to other imaging markers for myocardial function when LV curvatures are poorly visualized or in busy outdoors with time constraint.
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Nemes A, Kovács Z, Kormányos Á, Domsik P, Kalapos A, Ajtay Z, Lengyel C. Left ventricular apical rotation is associated with mitral annular function in healthy subjects. Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study. Physiol Int 2020; 107:145-154. [PMID: 32598330 DOI: 10.1556/2060.2020.00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
Introduction Left ventricular (LV) twist is considered an essential part of LV function due to oppositely directed LV basal and apical rotations. Several factors could play a role in determining LV rotational mechanics in normal circumstances. This study aimed to investigate the relationship between LV rotational mechanics and mitral annular (MA) size and function in healthy subjects. Methods The study comprised 118 healthy adult volunteers (mean age: 31.5 ± 11.8 years, 50 males). All subjects had undergone complete two-dimensional (2D) Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE) at the same time by the same echocardiography equipment. Results The normal mean LV apical and basal rotations proved to be 9.57 ± 3.33 and -3.75 ± 1.98°, respectively. LV apical rotation correlated with end-systolic MA diameter, area, perimeter, fractional area change, and fractional shortening, but did not correlate with any end-diastolic mitral annular morphologic parameters. The logistic regression model identified MA fractional area change as an independent predictor of ≤6° left ventricular apical rotation (P < 0.003). Conclusions Correlations could be detected between apical LV rotation and end-systolic MA size and function, suggesting relationships between MA dimensions and function and LV rotational mechanics.
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Affiliation(s)
- A Nemes
- 12nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Z Kovács
- 2Department of Cardiology, Szent Rókus Hospital, Baja, Hungary
| | - Á Kormányos
- 12nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - P Domsik
- 12nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - A Kalapos
- 12nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Z Ajtay
- 3Vilmos Zsigmondy SPA Hospital, Harkány, Hungary.,4Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - C Lengyel
- 51st Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Silbiger JJ, Bazaz R. The anatomic substrate of mitral annular contraction. Int J Cardiol 2020; 306:158-161. [DOI: 10.1016/j.ijcard.2019.11.129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022]
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Tang Z, Fan YT, Wang Y, Jin CN, Kwok KW, Lee APW. Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2019; 32:503-513. [PMID: 30679142 DOI: 10.1016/j.echo.2018.11.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS In patients with AF and absent LA contraction, the normal predominantly "atriogenic" annular dynamics become "ventriculogenic." Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. "Atrial" functional MR may not be purely an atrial disorder.
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Affiliation(s)
- Zhe Tang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yi-Ting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Wang
- Cardiology Department, Chinese PLA General Hospital, Beijing, China
| | - Chun-Na Jin
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Dumont KA, Kvitting JPE, Karlsen JS, Remme EW, Hausken J, Lundblad R, Fiane AE, Urheim S. Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2018; 32:303-316.e4. [PMID: 30293779 DOI: 10.1016/j.echo.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Three-dimensional (3D) echocardiography with multiplanar reconstruction (MPR) is used clinically to quantify the mitral annulus. MPR images are, however, presented on a two-dimensional screen, calling into question their accuracy. An alternative to MPR is an autostereoscopic holographic display that enables in-depth visualization of 3D echocardiographic data without the need for special glasses. The aim of this study was to validate an autostereoscopic display using sonomicrometry as a gold standard. METHODS In 11 anesthetized open-chest pigs, sonomicrometric crystals were placed along the mitral annulus and near the left ventricular apex. High-fidelity catheters measured left atrial and ventricular pressures. Adjustments of pre- and afterload were done by constriction of the inferior vena cava and the ascending aorta, respectively. Three-dimensional epicardial echocardiography was obtained from an apical view and converted to the autostereoscopic display. A 3D virtual semitransparent annular surface (VSAS) was generated to measure commissure width (CW), septal-lateral length, area of the mitral annular surface, nonplanarity angle, and the annular height-to-commissure width ratio in mid-systole and late diastole. RESULTS Mitral annular measurements from the 3D VSAS derived from the 3D echocardiographic images and autostereoscopic display correlated well with sonomicrometry over a range of loading conditions: CW length (r = 0.98, P < .00001), septal-lateral length (r = 0.98, P < .00001), annular surface area (r = 0.93, P < .001), nonplanarity angle (r = 0.87, P < .001), and annular height-to-commissure width ratio (r = 0.85, P < .01). The 3D VSAS showed better agreement with the sonomicrometric measurements compared with MPR. CONCLUSIONS Mitral annular measurements using 3D VSAS correlate well with sonomicrometry over a range of loading conditions and may represent a powerful tool for noninvasive quantification of mitral annular dynamics.
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Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | | | | | - Espen W Remme
- Institute for Surgical Research, The Intervention Center, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John Hausken
- Department of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Bergen, Norway
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Nochioka K, Quarta CC, Claggett B, Roca GQ, Rapezzi C, Falk RH, Solomon SD. Left atrial structure and function in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2018. [PMID: 28637305 DOI: 10.1093/ehjci/jex097] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aims Although cardiac amyloidosis (CA) is characterized by significant left atrial (LA) dilatation, the characteristics of LA function remain to be fully investigated. Methods and results We assessed LA function by speckle-tracking echocardiography in 124 patients with CA and sinus rhythm: 68 with light chain (AL), 29 with mutant (ATTRm), 27 with wild-type (ATTRwt) transthyretin amyloidosis. Conventional and strain-derived parameters, including LA peak longitudinal strain (LS) and strain rate (peak LSR: reservoir function; early LSR: conduit function; late LSR: active function), were assessed compared between CA patients and 20 healthy controls of similar age and gender. All LA function phases, including LA longitudinal strain, peak LSR, early and late LSR were significantly impaired in CA compared to healthy controls after adjusting for LA size, LV ejection fraction and LV filling pressures (E/E') (all P < 0.05). Peak LA LS was moderately correlated with LV global LS (R = -0.60, P < 0.001); late LSR was correlated with A wave at the level of LV inflow (R = -0.69, P < 0.001). Among the different CA subtypes, peak LS and LA active emptying fraction were worse in ATTRwt than AL and ATTRm [P < 0.05 after adjustment for age, sex, body mass index, systolic blood pressure, heart rate, LA volume index, severity of mitral regurgitation, left ejection fraction, and left ventricular end-diastolic pressure (E/E')]. Conclusion In CA, LA function was severely impaired and highly correlated with LV deformation. Differences in LA function between amyloid subtypes suggest that amyloid aetiology plays a role in the pathophysiology of cardiac dysfunction in CA.
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Affiliation(s)
- Kotaro Nochioka
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA.,Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Seiryo-machi 1-1 Aobaku Sendai, Miyagi 980-8574, Japan
| | - Candida Cristina Quarta
- Division of Medicine, National Amyloidosis Centre UCL, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.,Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bolonga, PAD 21,Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
| | - Gabriela Querejeta Roca
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
| | - Claudio Rapezzi
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bolonga, PAD 21,Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Rodney H Falk
- Department of Cardiology, Harvard Vanguard Medical Associates, Brigham and Women's Hospital Cardiac Amyloidosis Program, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
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11
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Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions? Indian Heart J 2018; 70:368-372. [PMID: 29961452 PMCID: PMC6034026 DOI: 10.1016/j.ihj.2017.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 08/13/2017] [Accepted: 08/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods Echocardiographic data obtained from 150 patients (mean age 56 ± 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.
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12
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Lo Q, Hee L, Batumalai V, Allman C, MacDonald P, Lonergan D, Delaney GP, Thomas L. Strain Imaging Detects Dose-Dependent Segmental Cardiac Dysfunction in the Acute Phase After Breast Irradiation. Int J Radiat Oncol Biol Phys 2017; 99:182-190. [PMID: 28816145 DOI: 10.1016/j.ijrobp.2017.05.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE We examined the utility of echocardiographic 2-dimensional speckle tracking strain imaging (SI) for the evaluation of segmental myocardial dysfunction before and after radiation therapy (RT) and the relationship to dose exposure. METHODS AND MATERIALS We prospectively recruited 40 women with left-sided breast cancer, undergoing only adjuvant RT to the left chest. Comparisons of traditional echocardiographic parameters and SI parameters at baseline and 6 weeks after RT were analyzed. Regional strain and strain rate (SR) parameters were obtained from all 18 left ventricular segments. The correlation of change in strain parameters with segmental radiation dose was examined. RESULTS We observed a significant reduction in global and segmental systolic strain parameters at 6 weeks after RT compared with baseline, with the largest decrement in the apical segments; this corresponded with the segments receiving the highest radiation dose exposure (apical peak systolic strain of -21.21% ± 3.49% before RT vs -18.69% ± 3.34% after RT, percentage change of 11.88%, P=.002; apical peak systolic SR of -1.17 ± 0.24 s-1 before RT vs -1.04 ± 0.19 s-1 after RT, percentage change of 11.11%, P=.008). There was a modest correlation between the apical segment systolic strain reduction and radiation dose exposure (apical segment Δ change and apical radiation dose, r=0.345, P=.031; apical segment percentage change and apical radiation dose, r=0.346, P=.031). A significant reduction in early diastolic SR was observed in the apical segments after treatment compared with baseline (apical early diastolic SR, 1.54 ± 0.45 s-1 before RT vs 1.35 ± 0.33 after RT s-1; percentage change, 12.34%; P=.034). CONCLUSIONS Two-dimensional SI detected dose-related regional myocardial dysfunction in the acute phase after RT in chemotherapy-naive left-sided breast cancer patients. Although the long-term effects remain unknown, this imaging modality may have a potential role in the evaluation of irradiation-related cardiotoxicity.
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Affiliation(s)
- Queenie Lo
- University of New South Wales, Sydney, Australia; Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia
| | - Leia Hee
- University of New South Wales, Sydney, Australia; Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia; Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Vikneswary Batumalai
- University of New South Wales, Sydney, Australia; Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia; Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Christine Allman
- Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia
| | - Peter MacDonald
- University of New South Wales, Sydney, Australia; Department of Cardiology, St Vincent's Hospital Sydney, Sydney, Australia
| | - Denise Lonergan
- Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia; Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Geoff P Delaney
- University of New South Wales, Sydney, Australia; Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia; Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Liza Thomas
- University of New South Wales, Sydney, Australia; Departments of Cardiology and Radiation Oncology, Liverpool Hospital, Sydney, Australia; University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia.
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Mohammadi S, Hedjazi A, Sajjadian M, Ghoroubi N, Mohammadi M, Erfani S. Study of the normal heart size in Northwest part of Iranian population: a cadaveric study. J Cardiovasc Thorac Res 2016; 8:119-125. [PMID: 27777697 PMCID: PMC5075360 DOI: 10.15171/jcvtr.2016.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/17/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction: The heart is in a muscular organ in the middle mediastinum. According to our knowledge, there is no standard data about the anthropologic parameters of normal Iranian hearts. Hence, the aim of the present study was to investigate the normal heart size in Iranian cadavers.
Methods: In a cross-sectional study, 550 cadavers (104 female/446 male) from June 2014 to July 2015 in the Razavi Khorasan province of Iran were included in the study. After approval of the Ethical Committee, cadavers were divided into 10 groups based on age groups. Length, width, weight, chordae tendineae, papillary muscles, and heart valves were measured using vernier caliper. Finally, data were analyzed using SPSS software.
Results: The mean values of the demographic data were as follows: age= 42.12 ± 21.34 years; weight = 60.38 ± 15.32 kg; height = 158.14 ± 23.77 cm; and BMI = 24.66 ± 17.60 kg/m2. The mean values of the heart length, width, chordae tendineae, pupillary muscles, weight, and index of the heart were 11.41 ± 2.15 cm, 8.21 ± 4.38 cm, 19.41 ± 6.70, 5.74 ± 1.96, 247.78 ± 62.27 grams, and 5.74 ± 1.96, respectively. In addition, the circumference of the tricuspid valve, circumference of the mitral valves, and tricuspid and mitral areas were 8.80 ± 1.11 cm, 9.43 ± 1.44 cm, 4.11 ± 0.71 cm2, and 4.50 ± 0.90 cm2, respectively.
Conclusion: Mean values of the heart’s length and width was similar to previous reports from western population. The circumference of the tricuspid valve was less than the textbook’s data, while circumference of the mitral valves was more than it. The study findings provide valuable information about standard data of the heart in the Iranian population, which is useful for surgeons as well as anthropologists. However, multi-center studies with a larger sample size are required to complete data about anatomical characteristics of normal hearts.
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Affiliation(s)
- Shabnam Mohammadi
- Microanatomy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ; Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Hedjazi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Maryam Sajjadian
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Naser Ghoroubi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Maryam Mohammadi
- Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Erfani
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Apor A, Nagy AI, Kovács A, Manouras A, Andrássy P, Merkely B. Three-dimensional dynamic morphology of the mitral valve in different forms of mitral valve prolapse - potential implications for annuloplasty ring selection. Cardiovasc Ultrasound 2016; 14:32. [PMID: 27528216 PMCID: PMC4986382 DOI: 10.1186/s12947-016-0073-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/25/2016] [Indexed: 02/02/2023] Open
Abstract
Background Real-time three-dimensional transesophageal echocardiography has increased our understanding of the distinct pathomechanisms underlying functional, ischaemic or degenerative mitral regurgitation. However, potential differences in dynamic morphology between the subtypes of degenerative mitral prolapse have scarcely been investigated. Methods In order to compare the dynamic behavior of the different phenotypes of degenerative mitral valve prolapse, real-time three-dimensional transesophageal echocardiography recordings of 77 subjects, 27 with Barlow disease (BD), 32 with Fibroelastic deficiency (FED) and 18 normal controls (NC) were analysed. Results Geometric annular and valvular parameters of the myxomatous patients were significantly larger compared to controls (BD vs. FED vs. NC 3D annular area: 15 ± 2.8 vs. 13.3 ± 2.4 vs. 10.6 ± 2.3cm2, all p < 0.01). Beside similar ellipticity, BD annuli were significantly flatter compared to FED. Myxomatous annuli appeared less dynamic than normals, with decreased overall 3D area change, however only the BD group differed from NC significantly (BD vs. FED vs. NC normalized 3D area change 4.40 vs. 6.81 vs. 9.69 %; BD vs. NC p = 0.000; FED vs. NC p = not significant, BD vs. FED p = 0.025). Conclusion BD and FED differ not only in terms of valve morphology, but also annular dynamics. Both pathologies are characterized by annular dilatation. However, in BD the annulus is remarkably flattened and hypodynamic, whereas in FED its saddle-shape and contractile function is relatively preserved. These features might influence the choice of repair technique and the selection of annuloplasty ring.
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Affiliation(s)
- Astrid Apor
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary.
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
| | | | - Péter Andrássy
- Bajcsy-Zsilinszky Hospital and Clinic, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Gaál J.u.9, Budapest, H-1122, Hungary
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Okafor IU, Santhanakrishnan A, Raghav VS, Yoganathan AP. Role of Mitral Annulus Diastolic Geometry on Intraventricular Filling Dynamics. J Biomech Eng 2016; 137:121007. [PMID: 26502376 DOI: 10.1115/1.4031838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Indexed: 11/08/2022]
Abstract
The mitral valve (MV) is a bileaflet valve positioned between the left atrium and ventricle of the heart. The annulus of the MV has been observed to undergo geometric changes during the cardiac cycle, transforming from a saddle D-shape during systole to a flat (and less eccentric) D-shape during diastole. Prosthetic MV devices, including heart valves and annuloplasty rings, are designed based on these two configurations, with the circular design of some prosthetic heart valves (PHVs) being an approximation of the less eccentric, flat D-shape. Characterizing the effects of these geometrical variations on the filling efficiency of the left ventricle (LV) is required to understand why the flat D-shaped annulus is observed in the native MV during diastole in addition to optimizing the design of prosthetic devices. We hypothesize that the D-shaped annulus reduces energy loss during ventricular filling. An experimental left heart simulator (LHS) consisting of a flexible-walled LV physical model was used to characterize the filling efficiency of the two mitral annular geometries. The strength of the dominant vortical structure formed and the energy dissipation rate (EDR) of the measured fields, during the diastolic period of the cardiac cycle, were used as metrics to quantify the filling efficiency. Our results indicated that the O-shaped annulus generates a stronger (25% relative to the D-shaped annulus) vortical structure than that of the D-shaped annulus. It was also found that the O-shaped annulus resulted in higher EDR values throughout the diastolic period of the cardiac cycle. The results support the hypothesis that a D-shaped mitral annulus reduces dissipative energy losses in ventricular filling during diastole and in turn suggests that a symmetric stent design does not provide lower filling efficiency than an equivalent asymmetric design.
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16
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Vedula V, George R, Younes L, Mittal R. Hemodynamics in the Left Atrium and Its Effect on Ventricular Flow Patterns. J Biomech Eng 2016; 137:111003. [PMID: 26329022 DOI: 10.1115/1.4031487] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Indexed: 11/08/2022]
Abstract
In the present study, we investigate the hemodynamics inside left atrium (LA) and understand its impact on the development of ventricular flow patterns. We construct the heart model using dynamic-computed tomographic images and perform simulations using an immersed boundary method based flow solver. We show that the atrial hemodynamics is characterized by a circulatory flow generated by the left pulmonary veins (LPVs) and a direct stream from the right pulmonary veins (RPVs). The complex interaction of the vortex rings formed from each of the PVs leads to vortex breakup and annihilation, thereby producing a regularized flow at the mitral annulus. A comparison of the ventricular flow velocities between the physiological and a simplified pipe-based atrium model shows that the overall differences are limited to about 10% of the peak mitral flow velocity. The implications of this finding on the functional morphology of the left heart as well the computational and experimental modeling of ventricular hemodynamics are discussed.
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17
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Silbiger JJ. Pitfalls in the Echocardiographic Evaluation of Mitral Annular Size, Shape, and Dynamics in Patients with Mitral Annular Calcification. J Am Soc Echocardiogr 2015. [PMID: 26209912 DOI: 10.1016/j.echo.2015.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Khamooshian A, Buijsrogge MP, De Heer F, Gründeman PF. Mitral Valve Annuloplasty Rings: Review of Literature and Comparison of Functional Outcome and Ventricular Dimensions. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:399-415. [DOI: 10.1177/155698451400900603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past decades, more than 40 mitral valve annuloplasty rings of various shapes and consistency were marketed for mitral regurgitation (MR), although the effect of ring type on clinical outcome remains unclear. Our objective was to review the literature and apply a simplification method to make rings of different shapes and rigidity more comparable. We studied relevant literature from MEDLINE and EMBASE databases related to clinical studies as well as animal and finite element models. Annuloplasty rings were clustered into 3 groups as follows: rigid (R), flexible (F), and semirigid (S). Only clinical articles regarding degenerative (DEG) or ischemic/dilated cardiomyopathy (ICM) MR were included and stratified into these groups. A total of 37 rings were clustered into R, F, and S subgroups. Clinical studies with a mean follow-up of less than 1 year and a reported mean etiology of valve incompetence of less than 60% were excluded from the analysis. Forty-one publications were included. Preimplant and postimplant end points were New York Heart Association class, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), and left ventricular end-diastolic dimension (LVEDD). Statistical analysis included paired-samples t test and analysis of variance with post hoc Bonferroni correction. P < 0.05 indicated statistical difference. Mean ± SD follow-up was 38.6 ± 27 and 29.7 ± 13.2 months for DEG and ICM, respectively. In DEG, LVEF remained unchanged, and LVESD decreased in all subgroups. In our analysis, LVEDD decreased only in F and R, and S did not change; however, the 4 individual studies showed a significant decline. In ICM, New York Heart Association class improved in all subgroups, and LVEF increased. Moreover, LVESD and LVEDD decreased only in F and S; R was underpowered (1 study). No statistical difference among R, F, and S in either ICM or DEG could be detected for all end points. Overall, owing to underpowered data sets derived from limited available publications, major statistical differences in clinical outcome between ring types could not be substantiated. Essential end points such as recurrent MR and survival were incomparable. In conclusion, ring morphology and consistency do not seem to play a major clinical role in mitral valve repair based on the present literature. Hence, until demonstrated otherwise, surgeons may choose their ring upon their judgment, tailored to specific patient needs.
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19
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Chandran KB, Kim H. Computational mitral valve evaluation and potential clinical applications. Ann Biomed Eng 2014; 43:1348-62. [PMID: 25134487 DOI: 10.1007/s10439-014-1094-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/09/2014] [Indexed: 01/15/2023]
Abstract
The mitral valve (MV) apparatus consists of the two asymmetric leaflets, the saddle-shaped annulus, the chordae tendineae, and the papillary muscles. MV function over the cardiac cycle involves complex interaction between the MV apparatus components for efficient blood circulation. Common diseases of the MV include valvular stenosis, regurgitation, and prolapse. MV repair is the most popular and most reliable surgical treatment for early MV pathology. One of the unsolved problems in MV repair is to predict the optimal repair strategy for each patient. Although experimental studies have provided valuable information to improve repair techniques, computational simulations are increasingly playing an important role in understanding the complex MV dynamics, particularly with the availability of patient-specific real-time imaging modalities. This work presents a review of computational simulation studies of MV function employing finite element structural analysis and fluid-structure interaction approach reported in the literature to date. More recent studies towards potential applications of computational simulation approaches in the assessment of valvular repair techniques and potential pre-surgical planning of repair strategies are also discussed. It is anticipated that further advancements in computational techniques combined with the next generations of clinical imaging modalities will enable physiologically more realistic simulations. Such advancement in imaging and computation will allow for patient-specific, disease-specific, and case-specific MV evaluation and virtual prediction of MV repair.
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Affiliation(s)
- Krishnan B Chandran
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, 52242, USA
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20
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Is it possible to expand a porcelain ring without breaking? J Thorac Cardiovasc Surg 2014; 147:1992. [PMID: 24837724 DOI: 10.1016/j.jtcvs.2014.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 01/30/2014] [Indexed: 11/21/2022]
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21
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Sizing the mitral annulus in healthy subjects and patients with mitral regurgitation: 2D versus 3D measurements from cardiac CT. Int J Cardiovasc Imaging 2013; 30:389-98. [DOI: 10.1007/s10554-013-0341-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
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22
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Zito C, Cusmà-Piccione M, Oreto L, Tripepi S, Mohammed M, Di Bella G, Falanga G, Oreto G, Lentini S, Carerj S. In Patients with Post-Infarction Left Ventricular Dysfunction, How Does Impaired Basal Rotation Affect Chronic Ischemic Mitral Regurgitation? J Am Soc Echocardiogr 2013; 26:1118-1129. [DOI: 10.1016/j.echo.2013.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Indexed: 11/27/2022]
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23
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Mahmood F, Shakil O, Mahmood B, Chaudhry M, Matyal R, Khabbaz KR. Mitral annulus: an intraoperative echocardiographic perspective. J Cardiothorac Vasc Anesth 2013; 27:1355-63. [PMID: 23962462 DOI: 10.1053/j.jvca.2013.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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24
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Bothe W, Rausch MK, Kvitting JPE, Echtner DK, Walther M, Ingels NB, Kuhl E, Miller DC. How do annuloplasty rings affect mitral annular strains in the normal beating ovine heart? Circulation 2012; 126:S231-8. [PMID: 22965988 DOI: 10.1161/circulationaha.111.084046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that annuloplasty ring implantation alters mitral annular strains in a normal beating ovine heart preparation. METHODS AND RESULTS Sheep had 16 radiopaque markers sewn equally spaced around the mitral annulus. Edwards Cosgrove partial flexible band (COS; n=12), St Jude complete rigid saddle-shaped annuloplasty ring (RSA; n=10), Carpentier-Edwards Physio (PHY; n=11), Edwards IMR ETlogix (ETL; n=11), and GeoForm (GEO; n=12) annuloplasty rings were implanted in a releasable fashion. Four-dimensional marker coordinates were obtained using biplane videofluoroscopy with the ring inserted (ring) and after ring release (control). From marker coordinates, a functional spatio-temporal representation of each annulus was generated through a best fit using 16 piecewise cubic Hermitian splines. Absolute total mitral annular ring strains were calculated from the relative change in length of the tangent vector to the annular curve as strains occurring from control to ring state at end-systole. In addition, average Green-Lagrange strains occurring from control to ring state at end-systole along the annulus were calculated. Absolute total mitral annular ring strains were smallest for COS and greatest for ETL. Strains for RSA, PHY, and GEO were similar. Except for COS in the septal mitral annular segment, all rings induced compressive strains along the entire annulus, with greatest values occurring at the lateral mitral annular segment. CONCLUSIONS In healthy, beating ovine hearts, annuloplasty rings (COS, RSA, PHY, ETL, and GEO) induce compressive strains that are predominate in the lateral annular region, smallest for flexible partial bands (COS) and greatest for an asymmetrical rigid ring type with intrinsic septal-lateral downsizing (ETL). However, the ring type with the most drastic intrinsic septal-lateral downsizing (GEO) introduced strains similar to physiologically shaped rings (RSA and PHY), indicating that ring effects on annular strain profiles cannot be estimated from the degree of septal-lateral downsizing.
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Affiliation(s)
- Wolfgang Bothe
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5247, USA
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25
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Tavlasoglu M. Is a radially self-expanding valved stent with neochordal support enough for better fixation in the mitral position? Eur J Cardiothorac Surg 2012; 43:202-3. [PMID: 22593184 DOI: 10.1093/ejcts/ezs269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Rausch MK, Bothe W, Kvitting JPE, Swanson JC, Miller DC, Kuhl E. Mitral valve annuloplasty: a quantitative clinical and mechanical comparison of different annuloplasty devices. Ann Biomed Eng 2012; 40:750-61. [PMID: 22037916 PMCID: PMC3288426 DOI: 10.1007/s10439-011-0442-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/08/2011] [Indexed: 10/16/2022]
Abstract
Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. In this article, we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted 11 flexible-incomplete, 11 semi-rigid-complete, and 12 rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably caused reduction in annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials.
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Affiliation(s)
- Manuel K Rausch
- Department of Mechanical Engineering, Stanford University, 496 Lomita Mall, Stanford, CA 94305, USA
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Kliger C, Ruiz CE. Percutaneous Treatment of Primary and Secondary Mitral Regurgitation: Overall Scope of the Problem. Interv Cardiol Clin 2012; 1:73-83. [PMID: 28582069 DOI: 10.1016/j.iccl.2011.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mitral regurgitation is a heterogeneous disorder requiring the understanding of complex mitral anatomy and pathophysiology. Advanced imaging has furthered our knowledge and ability to treat patients with this disorder. As the demand for less invasive treatment increases, a multitude of percutaneous options have emerged. This review is written for interventionalists to fully appreciate the overall scope of the problem of mitral regurgitation. Understanding and integrating mitral anatomy with pathophysiology, multimodality imaging, and current transcatheter mitral therapies are paramount for treating this disorder.
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Affiliation(s)
- Chad Kliger
- Lenox Hill Heart and Vascular Institute, Department of Cardiovascular Disease, Division of Structural and Congenital Heart Disease, 130 East 77th Street, 9th Floor Black Hall Building, New York, NY 10075, USA
| | - Carlos E Ruiz
- Lenox Hill Heart and Vascular Institute, Department of Cardiovascular Disease, Division of Structural and Congenital Heart Disease, 130 East 77th Street, 9th Floor Black Hall Building, New York, NY 10075, USA.
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28
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Hyodo E, Iwata S, Tugcu A, Oe Y, Koczo A, Shimada K, Muro T, Yoshikawa J, Yoshiyama M, Gillam LD, Hahn RT, Di Tullio MR, Homma S. Accurate measurement of mitral annular area by using single and biplane linear measurements: comparison of conventional methods with the three-dimensional planimetric method. Eur Heart J Cardiovasc Imaging 2011; 13:605-11. [DOI: 10.1093/ejechocard/jer300] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Di Mauro M, Gallina S, D'Amico MA, Izzicupo P, Lanuti P, Bascelli A, Di Fonso A, Bartoloni G, Calafiore AM, Di Baldassarre A. Functional mitral regurgitation: from normal to pathological anatomy of mitral valve. Int J Cardiol 2011; 163:242-248. [PMID: 22192280 DOI: 10.1016/j.ijcard.2011.11.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/10/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
Mitral valve (MV) is composed of several structures working in synchrony to open during diastole and close in systole within the high-pressure systemic environment. Its morphological features ensure a normal leaflet closure that prevents regurgitation of blood back into the left atrium causing loss of ventricular pressure and forward flow. The complex interactions of the normal MV are reliant on each component playing a complete role for the efficient working of the valve. In this review we firstly discuss the overall MV structure in terms of a complex make up of the annulus, the leaflets, their tendinous cords, and the supporting papillary muscles, and then the anatomical changes of each MV components due to left ventricular geometry and function alterations, underlying functional mitral regurgitation.
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Affiliation(s)
- Michele Di Mauro
- Dept. of Neuroscience and Imaging, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Sabina Gallina
- Dept. of Neuroscience and Imaging, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Maria Angela D'Amico
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Paola Lanuti
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Adriana Bascelli
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Alessia Di Fonso
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | | | | | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy.
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Mitral Annulus Dynamics Early after Valve Repair: Preliminary Observations of the Effect of Resectional Versus Non-Resectional Approaches. J Am Soc Echocardiogr 2011; 24:1233-42. [DOI: 10.1016/j.echo.2011.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Indexed: 11/17/2022]
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Mechanistic Insights into Ischemic Mitral Regurgitation: Echocardiographic and Surgical Implications. J Am Soc Echocardiogr 2011; 24:707-19. [DOI: 10.1016/j.echo.2011.04.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Indexed: 11/24/2022]
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Tan T, Cabrita IZ, Hensman D, Grogono J, Dhillo WS, Baynes KC, Eliahoo J, Meeran K, Robinson S, Nihoyannopoulos P, Martin NM. Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia. Clin Endocrinol (Oxf) 2010; 73:369-74. [PMID: 20550538 DOI: 10.1111/j.1365-2265.2010.03827.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cabergoline is a highly effective medical treatment for patients with hyperprolactinaemia. There is an increased risk of valvular heart disease in patients receiving cabergoline for Parkinson's disease. This study examined whether cabergoline treatment of hyperprolactinaemia is associated with a greater prevalence of valvulopathy. DESIGN Cross-sectional, two-dimensional echocardiographic study performed by a single echocardiographer. PATIENTS Seventy-two patients (median age 36 years, 19 men) receiving cabergoline for hyperprolactinaemia, and 72 controls prospectively matched for age, sex and cardiovascular risk factors. Measurements Assessment of valvular mobility, regurgitation and morphology. RESULTS Median cumulative dose exposure for cabergoline was 126 (58-258) mg, and patients had received cabergoline for 53 (26-96) months. The frequency of mild mitral regurgitation was identical (5/72, 7%) in patient and control groups. Mild aortic regurgitation was not significantly different between groups (4/72 [controls] vs 2/72 [patients], P = 0.681). There was only one case of tricuspid regurgitation, which was mild and observed in a cabergoline-treated patient. Nodular thickening of the right coronary cusp, noncoronary cusp or left coronary cusp of the aortic valve was observed at a similar frequency in both groups. There were no cases of extensive thickening of any valvular leaflet. CONCLUSION Our data demonstrates that there is no association between cabergoline treatment for hyperprolactinaemia and valvulopathy. This study therefore supports continued use of low-dose cabergoline for patients with hyperprolactinaemia.
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Affiliation(s)
- Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College, London, UK
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Van Mieghem NM, Piazza N, Anderson RH, Tzikas A, Nieman K, De Laat LE, McGhie JS, Geleijnse ML, Feldman T, Serruys PW, de Jaegere PP. Anatomy of the Mitral Valvular Complex and Its Implications for Transcatheter Interventions for Mitral Regurgitation. J Am Coll Cardiol 2010; 56:617-26. [DOI: 10.1016/j.jacc.2010.04.030] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/20/2010] [Accepted: 04/26/2010] [Indexed: 11/16/2022]
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Daimon M, Saracino G, Fukuda S, Koyama Y, Kwan J, Song JM, Agler DA, Gillinov AM, Thomas JD, Shiota T. Dynamic Change of Mitral Annular Geometry and Motion in Ischemic Mitral Regurgitation Assessed by a Computerized 3D Echo Method. Echocardiography 2010; 27:1069-77. [DOI: 10.1111/j.1540-8175.2010.01204.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bothe W, Kvitting JPE, Swanson JC, Hartnett S, Ingels NB, Miller DC. Effects of different annuloplasty rings on anterior mitral leaflet dimensions. J Thorac Cardiovasc Surg 2010; 139:1114-22. [PMID: 20412950 DOI: 10.1016/j.jtcvs.2009.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 12/01/2009] [Accepted: 12/13/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the effects of annuloplasty rings on anterior mitral leaflet dimensions. METHODS Sixteen radiopaque markers were sutured evenly spaced over the surface of the anterior mitral leaflet in 57 sheep. The following rings were implanted in a releasable fashion: size 28-mm Cosgrove-Edwards band (Edwards Lifesciences, Irvine, Calif) (n = 11), rigid saddle-shaped annuloplasty ring (St Jude Medical Inc, St Paul, Minn) (n = 12), Carpentier-Edwards Physio (Edwards Lifesciences) (n = 12), IMR-ETlogix (Edwards Lifesciences) (n = 10), and GeoForm (Edwards Lifesciences) (n = 12). Under acute open chest conditions, 4-dimensional marker coordinates were measured using biplane videofluoroscopy with the annuloplasty ring inserted and after annuloplasty ring release. Septal-lateral and commissure-commissure dimensions were calculated from opposing marker pairs on the septal-lateral and commissure-commissure aspect of the anterior mitral leaflet at end diastole and end systole. To assess changes in anterior mitral leaflet shape, a "planarity index" was assessed by calculating the root mean square values as distances of the 16 anterior mitral leaflet markers to a best fit anterior mitral leaflet plane at end systole. RESULTS At end diastole, anterior mitral leaflet septal-lateral and commissure-commissure dimensions did not change with the Cosgrove ring compared with control, whereas the rigid saddle-shaped annuloplasty ring and Physio, IMR-ETlogix, and GeoForm rings reduced anterior mitral leaflet commissure-commissure but not septal-lateral anterior mitral leaflet dimensions. At end systole, the septal-lateral anterior mitral leaflet dimension was smaller with the IMR-ETlogix and GeoForm rings, but did not change with the Cosgrove ring, rigid saddle-shaped annuloplasty ring, and Physio ring. Anterior mitral leaflet shape was unchanged in all 5 groups. CONCLUSION With no changes in anterior mitral leaflet planarity, the 4 complete, rigid rings (rigid saddle-shaped annuloplasty ring, Physio, IMR-ETlogix, and GeoForm) reduced the anterior mitral leaflet commissure-commissure dimension at end diastole. The IMR-ETlogix and GeoForm rings decreased the septal-lateral anterior mitral leaflet dimension at end systole, probably as the result of inherent disproportionate downsizing. These changes in anterior mitral leaflet geometry could perturb the stress patterns, which in theory may affect repair durability.
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Affiliation(s)
- Wolfgang Bothe
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. 94305-5247, USA
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Foster GP, Dunn A. Reply. J Am Soc Echocardiogr 2009. [DOI: 10.1016/j.echo.2009.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kvitting JPE, Sigfridsson A, Wigström L, Bolger AF, Karlsson M. Analysis of human myocardial dynamics using virtual markers based on magnetic resonance imaging. Clin Physiol Funct Imaging 2009; 30:23-9. [PMID: 19780762 DOI: 10.1111/j.1475-097x.2009.00900.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY BACKGROUND Myocardial dynamics are three-dimensional (3D) and time-varying. Cineradiography of surgically implanted makers in animals or patients is accurate for assessing these events, but this invasive method potentially alters myocardial motion. The aim of the study was to quantify myocardial motion using magnetic resonance imaging (MRI) and hence to provide a non-invasive approach to characterize 3D myocardial dynamics. METHODS Myocardial motion was quantified in ten normal volunteers by tracking the Lagrangian motion of individual points (i.e. virtual markers), based on time-resolved 3D phase-contrast MRI data and Fourier tracking. Nine points in the myocardium were tracked over the entire cardiac cycle, allowing a wire frame model to be generated and systolic and diastolic events identified. RESULTS Radius of curvature of the left ventricular (LV) wall was calculated from the virtual markers; the ratio between the anterior-posterior (AP) and septal-lateral (SL) walls in the LV shows an oval shape of the apical short axis plane at end systole (ES) and more circular at end diastole (ED). The AP/SL ratio for the basal plane shows an oval shape at ES and ED. We found that the rotation of the basal plane in ES was less compared to the apical plane [-2.0 +/- 2.2 versus 4.1 +/- 2.6 degrees (P<0.005)]. The apical plane rotated counter clock wise as viewed from the apex. CONCLUSION This new non-invasive tool, despite current limitations in temporal and spatial resolution, may provide a comprehensive set of virtual myocardial markers throughout the entire LV without the confounding effects introduced by surgical implantation.
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Itoh A, Ennis DB, Bothe W, Swanson JC, Krishnamurthy G, Nguyen TC, Ingels NB, Miller DC. Mitral annular hinge motion contribution to changes in mitral septal-lateral dimension and annular area. J Thorac Cardiovasc Surg 2009; 138:1090-9. [PMID: 19747697 DOI: 10.1016/j.jtcvs.2009.03.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 01/15/2009] [Accepted: 03/23/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The mitral annulus is a dynamic, saddle-shaped structure consisting of fibrous and muscular regions. Normal physiologic mechanisms of annular motion are incompletely understood, and more complete characterization is needed to provide rational basis for annuloplasty ring design and to enhance clinical outcomes. METHODS Seventeen sheep had radiopaque markers implanted; 16 around the annulus and 2 on middle anterior and posterior leaflet edges. Four-dimensional marker coordinates were acquired with biplanar videofluoroscopy at 60 Hz. Hinge angle was quantified between fibrous and muscular annular planes, with 0 degrees defined at end diastole, to characterize its contribution to alterations in mitral septal-lateral dimension and 2-dimensional total annular area throughout the cardiac cycle. RESULTS During isovolumic contraction (pre-ejection), hinge angle abruptly increased, reaching maximum (steepest saddle shape, change 18 degrees +/- 13 degrees ) at peak left ventricular pressure. During ejection, hinge angle did not change; it then decreased during early filling (change 2 degrees +/- 2 degrees ). Septal-lateral dimension and total area paralleled hinge angle dynamics and leaflet distance (anterior to posterior marker). Pre-ejection septal-lateral reduction was 13% +/- 7% (3.3 +/- 1.5 mm) from 9% muscular dimension fall and 18 degrees +/- 13 degrees hinge angle increase. CONCLUSIONS Pre-ejection increase in hinge angle contributes substantially to septal-lateral and total area reduction, facilitating leaflet coaptation. Semirigid annuloplasty rings or partial bands may preserve hinge motion, but possible recurrent annular dilatation could result in recurrent mitral regurgitation. Long-term clinical studies are required to determine who might benefit most from preserving intrinsic hinge motion without compromising repair durability.
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Affiliation(s)
- Akinobu Itoh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
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Ruiz CE, Kronzon I. The Wishful Thinking of Indirect Mitral Annuloplasty. Circ Cardiovasc Interv 2009; 2:271-2. [DOI: 10.1161/circinterventions.109.888586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos E. Ruiz
- From the Lenox Hill Heart and Vascular Institute of New York (C.E.R.) and Leon H. Charney Division of Cardiology (I.K.), New York University Medical School, New York, NY
| | - Itzhak Kronzon
- From the Lenox Hill Heart and Vascular Institute of New York (C.E.R.) and Leon H. Charney Division of Cardiology (I.K.), New York University Medical School, New York, NY
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Mitral annular shape, size, and motion in normals and in patients with cardiomyopathy: evaluation with computed tomography. Invest Radiol 2009; 44:218-25. [PMID: 19212270 DOI: 10.1097/rli.0b013e3181994a73] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prospectively, in healthy subjects and in patients with dilated cardiomyopathy (DCM) and hypertrophic obstructive cardiomyopathy (HOCM), the 3-dimensional (3D) shape, size, and motion of the mitral annulus (MA) using computed tomography (CT). MATERIALS AND METHODS Twenty patients with no cardiac abnormalities (referred to as normals), 15 with DCM, and 15 with HOCM as determined by echocardiography underwent contrast-enhanced, retrospectively electrocardiography (ECG)-gated 64-slice CT of the heart. The MA was manually segmented in 10% steps of the RR interval with dedicated 3D software employing the point-wrap algorithm. The MA shape, area size, change of the MA area, and apicobasal MA motion throughout the cardiac cycle was determined and compared between the groups. Intercommissural distances were measured with CT and compared with findings during surgery in 9 patients undergoing ring annuloplasty. RESULTS The MA was nonplanar in all phases and subjects, being largest in diastole and smallest in systole. The MA area was significantly (P < 0.001) larger in patients with DCM (11.5 +/- 4.1 cm/m) as compared with normals (5.5 +/- 0.9 cm/m) and HOCM (4.7 +/- 0.9 cm/m). The change of MA area throughout the cardiac cycle was significantly (P < 0.017) smaller in patients with DCM (12.2 +/- 3.3%/m) as compared with normals (20.0 +/- 7.9%/m) and HOCM (20.5 +/- 7.7%/m). The mean apicobasal motion was significantly (P < 0.017) smaller in patients with DCM (2.2 +/- 1.0 mm/m) as compared with normals (3.6 +/- 0.8 mm/m) and HOCM (2.7 +/- 0.7 mm/m). Intercommissural distances as determined by CT showed a good correlation (r = 0.68, P < 0.05) with intraoperative measurements (mean difference, 0.44 mm; limits of agreement, -2.73-3.62 mm). CONCLUSION Our study provides in vivo human data on the 3D shape, size, and motion of the MA in healthy subjects. Significant changes in size and motion of the MA were noted in patients with HOCM.
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Dasi LP, Sucosky P, De Zelicourt D, Sundareswaran K, Jimenez J, Yoganathan AP. Advances in Cardiovascular Fluid Mechanics: Bench to Bedside. Ann N Y Acad Sci 2009; 1161:1-25. [DOI: 10.1111/j.1749-6632.2008.04320.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Value of Augmented Reality-Enhanced Transesophageal Echocardiography (TEE) for Determining Optimal Annuloplasty Ring Size During Mitral Valve Repair. Ann Thorac Surg 2008; 86:1473-8. [DOI: 10.1016/j.athoracsur.2008.07.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 07/14/2008] [Accepted: 07/14/2008] [Indexed: 11/24/2022]
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Armen TA, Vandse R, Crestanello JA, Raman SV, Bickle KM, Nathan NS. Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 10:74-81. [PMID: 18490271 DOI: 10.1093/ejechocard/jen165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient's functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform annuloplasty ring using three-dimensional (3D) echocardiography. METHODS AND RESULTS Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4+/-0.2 to 0.9+/-0.3 (P-value<0.0001), mitral valve tenting volume from 13+/-1.7 to 3.2+/-0.3 mL (P-value<0.001), annulus area from 12.6+/-1.0 to 3.3+/-0.2 cm2 (P-value<0.0001), valve circumference from 13+/-0.5 to 7.3+/-0.3 cm (P-value<0.0001), septolateral distance from 2.1+/-0.1 to 1.4+/-0.06 cm (P-value<0.01) and intercommissural distance from 3.4+/-0.1 to 2.7+/-0.03 cm (P-value<0.03). There was significant decrease in the septolateral distance at the level of A2-P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1+/-0.3 to 1.3+/-0.3 (P-value<0.002). CONCLUSION The mitral valve annuloplasty with the Geoform ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry.
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Affiliation(s)
- Todd A Armen
- Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA
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Anwar AM, Soliman OII, Nemes A, Germans T, Krenning BJ, Geleijnse ML, Van Rossum AC, ten Cate FJ. Assessment of Mitral Annulus Size and Function by Real-time 3-Dimensional Echocardiography in Cardiomyopathy: Comparison with Magnetic Resonance Imaging. J Am Soc Echocardiogr 2007; 20:941-8. [PMID: 17555937 DOI: 10.1016/j.echo.2007.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to assess mitral annular (MA) size and function in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) using real-time 3-dimensional (3D) echocardiography (RT3DE). METHODS The study included 30 patients with HCM, 20 patients with DCM, and 30 control subjects. RT3DE measurements included end-systolic and end-diastolic MA area (MAA) (MAA(3D)), MA diameter(3D), MA fractional area change (MAFAC), and MA fractional shortening. In subgroup of 50 patients, magnetic resonance imaging (MRI) was used for MAA(MRI) and MA diameter(MRI) measurement. RESULTS End-diastolic MAA(3D) was larger in HCM than in control group (P < .0001). Higher MAFAC and MA fractional shortening were present in HCM than in control group (P = .001 and P = .006, respectively). End-systolic and end-diastolic MAA(3D) in DCM were higher than in HCM and control groups (P < .0001). Lower MAFAC and MA fractional shortening were present in DCM than in HCM and control groups (P < .0001). MAFAC correlated well with left ventricular function in control subjects (r = 0.94, P < .0001), whereas correlation was less in DCM (r = 0.53, P = .02) and HCM (r = 0.42, P < .01). RT3DE and MRI measurements were comparable. CONCLUSION RT3DE assessment of MA size and function in control subjects and patients with cardiomyopathy is accurate and well correlated with MRI.
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Affiliation(s)
- Ashraf M Anwar
- Cardiology Department, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt
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Anwar AM, Soliman OII, ten Cate FJ, Nemes A, McGhie JS, Krenning BJ, van Geuns RJ, Galema TW, Geleijnse ML. True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging. Int J Cardiovasc Imaging 2006; 23:541-7. [PMID: 17164985 DOI: 10.1007/s10554-006-9181-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mitral annulus assessment is of great importance for the diagnosis and treatment of mitral valve disease. The present study sought to assess the value of real-time three-dimensional echocardiography for the assessment of true mitral annulus diameter (MAD). METHODS One hundred and fifty patients (mean age 38 +/- 18 years) with adequate two-dimensional (2D) echocardiographic image quality underwent assessment of MAD(2D) and MAD(3D) (with real-time three-dimensional echocardiography). In a subgroup of 30 patients true MAD was validated with magnetic resonance imaging (MRI). RESULTS There was a good interobserver agreement for MAD(2D) (mean difference = -0.25 +/- 2.90 mm, agreement: -3.16, 2.66) and MAD(3D) (mean difference = 0.29 +/- 2.03, agreement = -1.74, 2.32). Measurements of MAD(2D) and MAD(3D) were well correlated (R = 0.81, P < 0.0001). However, MAD(3D) was significantly larger than MAD(2D) (3.7 +/- 0.9 vs. 3.3 +/- 0.8 cm, P < 0.0001). In the subgroup of 30 patients with MRI validation, MAD(3D) and MAD(MRI) were significantly larger than MAD(2D) (3.3 +/- 0.5 and 3.4 +/- 0.5 cm vs. 2.9 +/- 0.4 cm, both P < 0.001). There was no significant difference between MAD(MRI) and MAD(3D). CONCLUSION MAD(3D) can be reliably measured and is superior to MAD(2D) in the assessment of true mitral annular size.
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Affiliation(s)
- Ashraf M Anwar
- Thoraxcenter, Room Ba 302, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Roman KS, Nii M, Macgowan CK, Barrea C, Coles J, Smallhorn JF. The Impact of Patch Augmentation on Left Atrioventricular Valve Dynamics in Patients with Atrioventricular Septal Defects: Early and Midterm Follow-up. J Am Soc Echocardiogr 2006; 19:1382-92. [PMID: 17098142 DOI: 10.1016/j.echo.2006.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Left atrioventricular valve pericardial patch may prevent valve replacement. We assessed patch annular dynamics compared with conventional repair and normal annuli. METHODS Transesophageal 3-dimensional echocardiography was acquired preoperatively and postoperatively in atrioventricular septal defects (n = 10, 5 patch, 5 conventional repair). Real-time 3-dimensional annular motion at midterm was compared with that of healthy children (n = 10). Parameters were: annular area, perimeter, segmental diameter, bending angle, stenosis, and regurgitation. RESULTS Regurgitant jet area ratio decreased in both patient groups. Conventional repair reduced annular area (P = .02). Patch repair showed an annular area larger than normal (P = .01). Control subjects had increased systolic area whereas operative groups showed a reduction. Patch repair had segmental diameters similar to normal whereas conventional repair was inhomogeneous. Annular bending angle was maintained after operation. CONCLUSION Patch repair in pediatrics shows durability without shrinkage or expansion. Improved stenosis and regurgitation does not change by midterm. Operation causes increased annular stiffness and diminished compliance. Neither technique establishes normal annular eccentricity.
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Affiliation(s)
- Kevin S Roman
- Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Song JM, Fukuda S, Kihara T, Shin MS, Garcia MJ, Thomas JD, Shiota T. Value of mitral valve tenting volume determined by real-time three-dimensional echocardiography in patients with functional mitral regurgitation. Am J Cardiol 2006; 98:1088-93. [PMID: 17027577 DOI: 10.1016/j.amjcard.2006.05.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 11/24/2022]
Abstract
This study sought to evaluate mitral valve tenting volume (TnV) as a clinical parameter using real-time 3-dimensional echocardiography in patients with functional mitral regurgitation (MR). In 27 patients with functional MR and 4 controls without mitral disease, real-time 3-dimensional echocardiographic images were obtained to measure TnV frame by frame from presystole to end-systole. The maximal and minimal TnVs during systole were identified in each patient, and mitral annular areas and tenting heights were also measured. Using 2-dimensional echocardiography, tenting area (TnA) was measured from the apical long-axis, apical 4-chamber, and apical 2-chamber views. The regurgitant orifice area was measured by the proximal isovelocity surface area method. Maximal and minimal TnVs occurred at the time of 2 +/- 6% and 78 +/- 6% of whole systolic duration, respectively, and the systolic percentage change of TnV was related to that of tenting height but not to that of mitral annular area. TnA on the long-axis images was significantly larger than that on the 4- and 2-chamber images (2.5 +/- 1.4 vs 1.7 +/- 1.3 and 1.9 +/- 1.4 cm(2), respectively, p <0.001). Regurgitant orifice area was significantly correlated with maximal TnV (r = 0.90), minimal TnV (r = 0.86), and TnA on the long-axis (r = 0.79), 4-chamber (r = 0.75), and 2-chamber (r = 0.73) images. Among minimal TnV and 3 TnAs, minimal TnV was the only independent determinant of regurgitant orifice area (p <0.001). Minimal TnV >or=3.90 ml identified significant functional MR with a sensitivity of 86% and a specificity of 100%. In conclusion, TnV derived from real-time 3-dimensional echocardiography is a preferable novel single index for assessing mitral valve tethering in functional MR to TnA that is dependent on the location of 2-dimensional planes.
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Affiliation(s)
- Jong-Min Song
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Maselli D, Guarracino F, Chiaramonti F, Mangia F, Borelli G, Minzioni G. Percutaneous mitral annuloplasty: an anatomic study of human coronary sinus and its relation with mitral valve annulus and coronary arteries. Circulation 2006; 2:557-64. [PMID: 16864726 DOI: 10.1161/circinterventions.109.873281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To allow performance of "stand-alone" mitral annuloplasty with minimal invasiveness, percutaneous techniques consisting of delivery into the coronary sinus (CS) of devices intended to shrink the mitral valve annulus have recently been tested in animal models. These techniques exploit the anatomic proximity of the CS and mitral valve annulus in ovine or dogs. Knowledge of a detailed anatomic relationship between the CS, coronary arteries, and mitral valve annulus in humans is essential to define the safety and efficacy of percutaneous techniques in clinical practice. We sought to determine the qualitative and quantitative anatomic relationships between CS and surrounding structures in human hearts. METHODS AND RESULTS The distance from the CS to the mitral valve annulus and the relationship between the CS and surrounding structures were studied in 61 excised cadaveric human hearts. Maximal distance from the CS to the mitral valve annulus was found to be up to 19 mm (mean, 9.7+/-3.2 mm). A diagonal or ramus branch, main circumflex artery, or its branches were located between anterior interventricular vein/CS and the mitral valve annulus in 16.4% and 63.9% of cases, respectively. CONCLUSIONS Surgical anatomy suggests that in humans the CS is located behind the left atrial wall at a significant distance from the mitral valve annulus. Percutaneous mitral annuloplasty devices probably shrink the mitral valve annulus only by an indirect traction mediated by the left atrial wall; a theoretical risk of compressing coronary artery branches exists. Chronic studies are needed to address this problem and to determine long-term efficacy of such methods.
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Affiliation(s)
- Daniele Maselli
- Cardio-Thoracic Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Clark TJ, Sheehan FH, Bolson EL. Characterizing the normal heart using quantitative three-dimensional echocardiography. Physiol Meas 2006; 27:467-508. [PMID: 16603799 DOI: 10.1088/0967-3334/27/6/004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present normative data on cardiac volume, geometry and shape derived using three-dimensional echocardiography (3-DE). Three-dimensional reconstructions were created using the piecewise smooth surface subdivision (PSSS) reconstruction technique of the left and right ventricular (LV and RV) endocardium and the mitral and tricuspid annuli (MA and TA) of 67 normal subjects. We derived LV end-diastolic (ED) and end-systolic (ES) volume indices (VI) of 76.5 +/- 16.8 ml m(-2) and 35.3 +/- 14.1 ml m(-2), LV ejection fraction (EF) of 56.1 +/- 9.93%, RV EDVI and ESVI of 93.2 +/- 20.0 ml m(-2) and 49.9 +/- 13.5 ml m(-2) and RVEF of 47.3 +/- 7.69%, along with data on the geometry and shape of the MA, TA, LV and RV. There was no pattern of consistent understatement or overstatement of volumes or dimensions compared with other imaging modalities, and observed variance in data can largely be accounted for through examination of the physics or protocol of each modality.
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Affiliation(s)
- T J Clark
- University of Washington Cardiovascular Research and Training Center, 1959 NE Pacific St, Box 356422, Seattle, WA 98195, USA.
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