Impact of aortic valve replacement for aortic stenosis on dynamic mitral annular motion and geometry

Citation:

Warraich HJ, Matyal R, Bergman R, Hess PE, Khabbaz K, Manning WJ, Mahmood F. Impact of aortic valve replacement for aortic stenosis on dynamic mitral annular motion and geometry. Am J Cardiol. 2013;112 :1445-9.

Date Published:

Nov 1

Abstract:

The impact of aortic valve replacement (AVR) on the dynamic geometry and motion of the mitral annulus remains unknown. We analyzed the effects of AVR on the dynamic geometry and motion of the mitral annulus. We used 3-dimensional transesophageal echocardiography to analyze 39 consecutive patients undergoing elective surgical AVR for aortic stenosis. Intraoperative 3-dimensional transesophageal echocardiography was performed immediately before and after AVR. Volumetric data sets were analyzed using a software package capable of dynamically tracking the mitral annulus and leaflets during the entire systolic ejection phase. After AVR, there were significant decreases (p <0.01) in annular dimensions such as anteroposterior (3.5 +/- 0.1 vs 3.2 +/- 0.1 cm), anterolateral-posteromedial (3.7 +/- 0.1 vs 3.5 +/- 0.1 cm), and commissural diameters (3.7 +/- 0.1 vs 3.3 +/- 0.1 cm), as well as annular circumference (12.0 +/- 0.30 vs 11.1 +/- 0.2 cm) and 3-dimensional mitral annular area (mean 10.9 +/- 0.6 vs 9.3 +/- 0.3 cm(3)). Vertical mitral annular displacement was also reduced (6.2 +/- 3.1 vs 4.3 +/- 2.2 mm). Mitral annular nonplanarity angle (154 +/- 1.5 degrees vs 161 +/- 1.6 degrees ) and aorto-mitral angle (133 +/- 3.3 degrees vs 142 +/- 2.0 degrees ) were both increased after AVR, suggesting reduced nonplanar shape of the mitral annulus and reduced aorto-mitral flexion. In conclusion, these data demonstrate that mitral annular size is reduced immediately after AVR and that the dynamic motion of the mitral annulus is restricted. These findings may have important clinical implications for patients undergoing AVR with concurrent mitral regurgitation.

Notes:

Warraich, Haider JMatyal, RobinaBergman, RemcoHess, Philip EKhabbaz, KamalManning, Warren JMahmood, FerozeengComparative StudyAm J Cardiol. 2013 Nov 1;112(9):1445-9. doi: 10.1016/j.amjcard.2013.06.013. Epub 2013 Jul 26.