Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation


Khabbaz KR, Mahmood F, Shakil O, Warraich HJ, Gorman, J. H. 3rd, Gorman RC, Matyal R, Panzica P, Hess PE. Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation. Ann Thorac Surg. 2013;95 :105-10.

Date Published:



BACKGROUND: Mitral valve (MV) annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV annular geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV annular geometry associated with FMR. METHODS: Intraoperative 3D transesophageal echocardiographic data obtained from 34 patients with FMR and 15 controls undergoing cardiac operations were dynamically analyzed for differences in mitral annular geometry with TomTec 4D MV Assessment 2.0 software (TomTec Imaging Systems GmbH, Munich, Germany). RESULTS: In patients with FMR, the mean mitral annular area (14.6 cm(2) versus 9.6 cm(2)), circumference (14.1 cm versus 11.4 cm), anteroposterior (4.0 cm versus 3.0 cm) and anterolateral-posteromedial (4.3 cm versus 3.6 cm) diameters, tenting volume (6.2 mm(3) versus 3.5 mm(3)) and nonplanarity angle (NPA) (154 degrees +/- 15 versus 136 degrees +/- 11) were greater at all points during systole compared with controls (p < 0.01). Vertical mitral annular displacement (5.8 mm versus 8.3 mm) was reduced in FMR compared with controls (p < 0.01). CONCLUSIONS: There are significant differences in dynamic mitral annular geometry between patients with FMR and those without. We were able to analyze these changes in a clinically feasible fashion. Ready availability of this information has the potential to aid comprehensive quantification of mitral annular function and possibly assist in both clinical decision making and annuloplasty ring selection.


Khabbaz, Kamal RMahmood, FerozeShakil, OmairWarraich, Haider JGorman, Joseph H 3rdGorman, Robert CMatyal, RobinaPanzica, PeterHess, Philip EengR01 HL063954/HL/NHLBI NIH HHS/R01 HL103723/HL/NHLBI NIH HHS/R01-HL 103723/HL/NHLBI NIH HHS/Comparative StudyResearch Support, N.I.H., ExtramuralNetherlandsAnn Thorac Surg. 2013 Jan;95(1):105-10. doi: 10.1016/j.athoracsur.2012.08.078. Epub 2012 Oct 25.