Dynamic changes in the ischemic mitral annulus: Implications for ring sizing.
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Date
2016-01
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Abstract
Objectives: Contrary to the rest of the mitral annulus, inter‑trigonal distance is known to be relatively less dynamic
during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty
ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic
mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does
not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR
and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative
three‑dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs
undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically
analyzed using Philips Qlab® software. Results: Overall, regurgitant valves were larger in area and less dynamic
than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA)
during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral‑posteromedial
diameters and inter‑trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs
in both groups. However, inter‑trigonal distance showed the least percentage change across the cardiac cycle
and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in
regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The
echocardiographically identified inter‑trigonal distance does not change significantly during the cardiac cycle.
Description
Keywords
Ischemic mitral regurgitation, Mitral annulus, Mitral valve repair, Three‑dimensional echocardiography
Citation
Owais Khurram, Montealegre-Gallegos Mario, Jeganathan Jelliffe, Matyal Robina, Khabbaz Kamal R, Mahmood Feroze. Dynamic changes in the ischemic mitral annulus: Implications for ring sizing. Annals of Cardiac Anaesthesia. 2016 Jan; 19(1): 15-19.