CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography
Nozomi Watanabe, MD, FACC*,*,
Yasuo Ogasawara, PhD ,
Yasuko Yamaura, MD*,
Takahiro Kawamoto, MD*,
Eiji Toyota, MD*,
Takashi Akasaka, MD* and
Kiyoshi Yoshida, MD, FACC*
* Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
Department of Medical Engineering and Systems of Cardiology, Kawasaki Medical School, Kurashiki, Japan
Manuscript received September 25, 2004;
accepted November 11, 2004.
* Reprint requests and correspondence: Dr. Nozomi Watanabe, Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
(Email: non{at}med.kawasaki-m.ac.jp).
OBJECTIVES: We sought to investigate the geometric changes of the mitral leaflets and annulus, clarify the maximum tenting site of the leaflets, and quantify the valve tenting in ischemic mitral regurgitation (MR) using three-dimensional (3D) echocardiography.
BACKGROUND: Although the understanding of the mechanisms of ischemic MR has advanced recently, the geometric changes of the mitral leaflets and annulus have been assessed by two-dimensional echocardiography in the clinical setting, despite the unique configuration of the leaflets and annulus.
METHODS: Utilizing real-time 3D echocardiography, we obtained transthoracic volumetric images in 12 patients with ischemic MR presenting with global left ventricular dysfunction and in 10 controls. Original software was used to crop the 3D data into 18 radial planes, and we marked the mitral annulus and leaflets in each plane in mid-systole. The 3D images of the leaflets and annulus were reconstructed for the quantitative measurements.
RESULTS: In ischemic MR, the annulus flattened with apparent tenting of the leaflets. Maximum and mean tenting length were longer and tenting volume was larger in ischemic MR than control subjects (maximum tenting length: 9.8 ± 2.0 mm vs. 3.1 ± 1.2 mm, p < 0.0001, mean tenting length: 3.7 ± 0.9 mm vs. 0.7 ± 0.5 mm, p < 0.0001, tenting volume: 4.09 ± 1.22 ml vs. 0.45 ± 0.29 ml, p < 0.0001). The maximum tenting site was located in anterior leaflet in all patients.
CONCLUSIONS: We clearly demonstrated 3D geometric deformity of the mitral leaflets and annulus in ischemic MR using novel software for creating images by 3D echocardiography. This technique will be helpful in making a proper decision for the surgical strategy in each patient.
|
Abbreviations and Acronyms
| | EDV = end-diastolic volume | | EF = ejection fraction | | ESV = end-systolic volume | | LV = left ventricle | | MI = myocardial infarction | | MR = mitral regurgitation | | PISA = proximal isovelocity surface area | | ROA = regurgitant orifice area | | 3D = three-dimensional | | 2D = two-dimensional |
|
This article has been cited by other articles:
|
|
|
|
 
C. Sonne, L. Sugeng, N. Watanabe, L. Weinert, K. Saito, M. Tsukiji, K. Yoshida, M. Takeuchi, V. Mor-Avi, and R. M. Lang
Age and body surface area dependency of mitral valve and papillary apparatus parameters: assessment by real-time three-dimensional echocardiography
Eur J Echocardiogr,
September 16, 2008;
(2008)
jen237v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. P. Ryan, B. M. Jackson, T. J. Eperjesi, T. J. Plappert, M. St John-Sutton, R. C. Gorman, and J. H. Gorman III
A methodology for assessing human mitral leaflet curvature using real-time 3-dimensional echocardiography
J. Thorac. Cardiovasc. Surg.,
September 1, 2008;
136(3):
726 - 734.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. Armen, R. Vandse, J. A. Crestanello, S. V. Raman, K. M. Bickle, and N. S. Nathan
Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography
Eur J Echocardiogr,
May 13, 2008;
(2008)
jen165v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W.M. Fedak, P. M. McCarthy, and R. O. Bonow
Evolving Concepts and Technologies in Mitral Valve Repair
Circulation,
February 19, 2008;
117(7):
963 - 974.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Komeda and T. Shimamoto
Cutting secondary chordae and placing dual taut stitches between the anterior mitral fibrous annulus and the heads of each papillary muscle to treat ischemic mitral regurgitation without deteriorating left ventricular function
J. Thorac. Cardiovasc. Surg.,
January 1, 2008;
135(1):
226 - 227.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. I. Fann, N. B. Ingels Jr., and D. C. Miller
Pathophysiology of Mitral Valve Disease
Card. Surg. Adult,
January 1, 2008;
3(2008):
973 - 1012.
[Full Text]
|
|
|
|
|
|
|
L. P. Ryan, B. M. Jackson, L. M. Parish, H. Sakamoto, T. J. Plappert, M. St. John-Sutton, J. H. Gorman III, and R. C. Gorman
Mitral Valve Tenting Index for Assessment of Subvalvular Remodeling
Ann. Thorac. Surg.,
October 1, 2007;
84(4):
1243 - 1249.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. P. Ryan, B. M. Jackson, Y. Enomoto, L. Parish, T. J. Plappert, M. G. St. John-Sutton, R. C. Gorman, and J. H. Gorman III
Description of regional mitral annular nonplanarity in healthy human subjects: A novel methodology
J. Thorac. Cardiovasc. Surg.,
September 1, 2007;
134(3):
644 - 648.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Ryan, B. Jackson, L. Parish, H. Sakamoto, T. Plappert, M. St. J. Sutton, J. Gorman III, and R. Gorman
Quantification and localization of mitral valve tenting in ischemic mitral regurgitation using real-time three-dimensional echocardiography
Eur. J. Cardiothorac. Surg.,
May 1, 2007;
31(5):
839 - 844.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Lang, V. Mor-Avi, L. Sugeng, P. S. Nieman, and D. J. Sahn
Three-Dimensional Echocardiography: The Benefits of the Additional Dimension
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
2053 - 2069.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fukuda, G. Saracino, Y. Matsumura, M. Daimon, H. Tran, N. L. Greenberg, T. Hozumi, J. Yoshikawa, J. D. Thomas, and T. Shiota
Three-Dimensional Geometry of the Tricuspid Annulus in Healthy Subjects and in Patients With Functional Tricuspid Regurgitation: A Real-Time, 3-Dimensional Echocardiographic Study
Circulation,
July 4, 2006;
114(1_suppl):
I-492 - I-498.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Kuwahara, Y. Otsuji, Y. Iguro, T. Ueno, F. Zhu, N. Mizukami, K. Kubota, K. Nakashiki, T. Yuasa, B. Yu, et al.
Mechanism of Recurrent/Persistent Ischemic/Functional Mitral Regurgitation in the Chronic Phase After Surgical Annuloplasty: Importance of Augmented Posterior Leaflet Tethering
Circulation,
July 4, 2006;
114(1_suppl):
I-529 - I-534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Weyman
The Year in Echocardiography
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
856 - 863.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas
Highlights of the Year in JACC 2005
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
184 - 202.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Yamaura, N. Watanabe, Y. Ogasawara, N. Wada, T. Kawamoto, E. Toyota, T. Akasaka, K. Tanemoto, and K. Yoshida
Geometric change of mitral valve leaflets and annulus after reconstructive surgery for ischemic mitral regurgitation: Real-time 3-dimensional echocardiographic study
J. Thorac. Cardiovasc. Surg.,
November 1, 2005;
130(5):
1459 - 1461.
[Full Text]
[PDF]
|
|
|
|
