NOVEL METHOD OF MITRAL REGURGITATION VOLUMETRIC QUANTIFICATION USING THREE-DIMENSIONAL MULTIPLE PLANAR RECONSTRUCTION FOR DIRECT MITRAL ANNULUS PLANIMETRY CALCULATION OF STROKE VOLUME

Introduction: 3D color Doppler allows a direct measurement of Vena Contracta (VC) area in patients with mitral regurgitation (MR), without the need for geometric assumptions. Hypothesis: 3D color Doppler VC area provides a more accurate assessment of MR severity than the conventional 2D color Doppler VC diameter. Methods: Patients with ≥ mild MR underwent 2D and 3D color Doppler and a quantitative echo-Doppler study. 2D VC diameter was measured from a zoomed parasternal long-axis view. 3D VC area was acquired using real-time 3D (Philips) and measured off-line (TomTec). MR severity was assessed both quantitatively, as effective regurgitant orifice area from pulsed Doppler [EROA = (mitral stroke volume - aortic stroke volume)/MR time velocity integral], and semi-quantitatively as recommended by the American Society of Echocardiography. Results: 61 patients (65 ± 15 years) were studied. MR severity was mild in 25%, moderate in 36%, and moderate to severe or severe in 39%. Mitral valve pathology was prolapse in 33%, restricted closure in 44% and annular calcification in 7%. Regurgitant MR jet was eccentric in 49% of patients. For all patients, 3D VC area correlated significantly with EROA, better than 2D VC diameter (figure ). The advantage of 3D VC area over 2D VC diameter was more pronounced in eccentric jets (r=0.76, p< 0.001 vs. r=0.5, p =0.006, respectively) and in moderate to severe or severe MR (r=0.65, p<0.001 vs. r =0.13, p=0.54, respectively). Conclusions : Measurement of VC area is feasible with real-time 3D and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.

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Relationship between mitral annular and left atrial function as assessed by three-dimensional speckle-tracking echocardiography in healthy volunteers. Results from the MAGYAR-Healthy Study

Orvosi Hetilap ◽

10.1556/oh.2014.29975 ◽

2014 ◽

Vol 155 (38) ◽

pp. 1517-1523 ◽

Cited By ~ 1

Author(s):

Péter Domsik ◽

Anita Kalapos ◽

Csaba Lengyel ◽

Andrea Orosz ◽

Tamás Forster ◽

...

Keyword(s):

Stroke Volume ◽

Healthy Volunteers ◽

Left Atrium ◽

Healthy Subjects ◽

Left Atrial ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Three Dimensional ◽

Mitral Annulus ◽

Functional Parameters

Introduction: Left atrium is a heart chamber with dinamic motion communicating with left ventricle through the mitral valve and its annulus. Aim: The aim of the present study was to analyse whether relationships could exist between three-dimensional speckle-tracking echocardiography-derived morphologic and functional parameters of the left atrium and mitral annulus in healthy subjects. Method: The present study comprised 35 healthy volunteers. Maximum (Vmax) and minimum (Vmin) left atrial volumes and left atrial volume before atrial contraction (VpreA) were measured, and several functional parameters based on these volumes were calculated in all cases. Morphologic and functional characteristics of the mitral annulus were also determined. Results: While Vmax showed correlations with both systolic and diastolic mitral annulus parameters, Vmin-VpreA correlated with only systolic ones. While total left atrial stroke volume correlated with both systolic and diastolic mitral annular parameters, passive left atrial stroke volume showed correlations only with diastolic ones. Conclusions: Correlations exist between left atrial and mitral annular morphological and functional characteristics in healthy subjects. Orv. Hetil., 2014, 155(38), 1517–1523.

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A multiplanar three dimensional echocardiographic study of mitral valvar annular function in children with normal and regurgitant valves

Cardiology in the Young ◽

10.1017/s1047951108002242 ◽

2008 ◽

Vol 18 (4) ◽

pp. 379-385 ◽

Cited By ~ 6

Author(s):

Tara Bharucha ◽

Muthukumaran C. Sivaprakasam ◽

Kevin S. Roman ◽

Joseph J. Vettukattil

Keyword(s):

Mitral Regurgitation ◽

Three Dimensional ◽

Normal Subjects ◽

Mitral Annulus ◽

Mean Value ◽

Left Ventricular ◽

Two Dimensions ◽

Normal Children ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography

AbstractIntroductionThe mitral valvar complex is difficult to visualise accurately in only two dimensions. Three-dimensional echocardiography gives new insight into the dynamic changes of intra-cardiac structures during the cardiac cycle. The aim of this study was to study the mitral annulus in systole and diastole in normal children using three-dimensional echocardiography, and to analyse the effect of regurgitation on annular function.Materials and methodsThree-dimensional echocardiographic datasets, acquired in 11 consecutive subjects with mitral regurgitation, and 20 normal subjects, were analysed offline using simultaneous multiplanar review.ResultsThe mitral valvar annular area decreased in diastole, and increased in systole, in both groups. The annulus in patients with mitral regurgitation is dilated compared to normal subjects, the systolic value for those with regurgitation having a mean of 6.79 plus or minus 2.55 centimetres2/metres2, and the diastolic value a mean of 5.01 plus or minus 1.78 centimetres2/metres2, as opposed to a systolic mean value of 5.28 centimetres2/metres2 plus or minus 1.68, p = 0.091, and diastolic mean value of 3.05 centimetres2/metres2 plus or minus 0.90, in normal subjects (p less than 0.0001). The proportional change in mitral valvar annular area from systole to diastole showed a trend towards being smaller in those with mitral regurgitation, although this did not reach significance (24.8% versus 41.13%, p equal to 0.249). Analysis of subgroups of patients with moderate or severe mitral regurgitation showed mitral excursion, expressed as percentage of left ventricular length, to be significantly less than in normal subjects, at 12.78 plus or minus 5.10% versus 15.84 plus or minus 4.23% (p equal to 0.012).ConclusionsMitral valvar annular area in children decreases in diastole, and increases in systole. In those with mitral regurgitation, the annulus is dilated and the dynamic annular function is depressed.

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VOLUMETRIC QUANTIFICATION OF REGURGITANT VOLUME IN ASYMPTOMATIC SEVERE DEGENERATIVE MITRAL REGURGITATION BY ECHOCARDIOGRAPHY AND CARDIAC MRI WITH INDEPENDENT VALIDATION OF FORWARD STROKE VOLUME BY POSITRON EMISSION TOMOGRAPHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)35362-7 ◽

2017 ◽

Vol 69 (11) ◽

pp. 1973

Author(s):

Tomasz Baron ◽

Lovisa Holm Orndahl ◽

Tanja Kero ◽

Jens Sorensen ◽

Tomas Bjerner ◽

...

Keyword(s):

Positron Emission Tomography ◽

Mitral Regurgitation ◽

Stroke Volume ◽

Cardiac Mri ◽

Emission Tomography ◽

Regurgitant Volume ◽

Independent Validation ◽

Forward Stroke ◽

Positron Emission ◽

Volumetric Quantification

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Three-dimensional reconstruction of the mitral annulus: Comparison of normal adults versus patients with ischemic mitral regurgitation

Journal of the American Society of Echocardiography ◽

10.1016/s0894-7317(96)90181-9 ◽

1996 ◽

Vol 9 (3) ◽

pp. 368

Keyword(s):

Mitral Regurgitation ◽

Three Dimensional ◽

Mitral Annulus ◽

Ischemic Mitral Regurgitation ◽

Three Dimensional Reconstruction ◽

Dimensional Reconstruction ◽

Normal Adults

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Changes in mitral annulus and leaflets size are related to regurgitation severity in organic mitral regurgitation: a three-dimensional transthoracic study

European Heart Journal ◽

10.1093/eurheartj/eht310.p4750 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4750-P4750

Author(s):

S. Mihaila ◽

D. Muraru ◽

L. P. Badano ◽

S. Casablana ◽

D. Peluso ◽

...

Keyword(s):

Mitral Regurgitation ◽

Three Dimensional ◽

Mitral Annulus

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Mitral Annulus Flattens in Ischemic Mitral Regurgitation: Geometric Differences Between Inferior and Anterior Myocardial Infarction

Circulation ◽

10.1161/circulationaha.104.524595 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Cited By ~ 2

Author(s):

Nozomi Watanabe ◽

Yasuo Ogasawara ◽

Yasuko Yamaura ◽

Nozomi Wada ◽

Takahiro Kawamoto ◽

...

Keyword(s):

Myocardial Infarction ◽

Mitral Regurgitation ◽

Three Dimensional ◽

Mitral Annulus ◽

Control Area ◽

Ischemic Mitral Regurgitation ◽

Anterior Myocardial Infarction ◽

3 Dimensional ◽

Curved Annulus ◽

Dimensional Echocardiography

Background— New surgical strategies to restore the saddle shape of the mitral annulus are expected to increase annuloplasty effectiveness. Preoperative and postoperative configuration of the curved annulus, however, is difficult to quantify with 2-dimensional echocardiography. We sought to investigate the geometric deformity in the mitral annulus in ischemic mitral regurgitation (MR), comparing inferior and anterior myocardial infarction (MI) with the use of a custom quantitation software system with transthoracic 3-dimensional echocardiography. Methods and Results— We performed real-time 3-dimensional echocardiography in 23 patients with ischemic MR attributable to inferior MI or anterior MI and in 10 controls. Three-dimensional data were cropped into 18 radial planes, and we manually marked the annulus in mid systole. Three-dimensional annular images were reconstructed, and annular circumferences, areas, and heights were quantified. Annulus was significantly more dilated and flattened in ischemic MR than in controls and was further deformed in anterior MI as compared with inferior MI (control: circumference 9.9±0.7 cm, area 9.6±0.5 cm 2 , height 5.0±0.7 mm; inferior MI: circumference 11.5±1.2 cm [ P <0.01 compared with control], area 11.4±2.0 cm 2 [ P <0.05 compared with control], height 3.5±1.6 mm [ P <0.05 compared with control]; anterior MI: circumference 14.2±2.4 cm [ P <0.0001 compared with control, P <0.05 compared with inferior MI], area 13.7±2.8 cm 2 ] P <0.01 compared with control, P <0.05 compared with inferior MI], height 1.7±1.5 mm [ P <0.0001 compared with control, P <0.05 compared with inferior MI]). Conclusions— Mitral annulus flattens in ischemic MR. Deformity of the mitral annulus was greater in anterior MI group than in the inferior MI group.

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Mechanistic Insights Into Posterior Mitral Leaflet Inter-Scallop Malcoaptation During Acute Ischemic Mitral Regurgitation

Circulation ◽

10.1161/01.cir.0000032874.55215.82 ◽

2002 ◽

Vol 106 (12_suppl_1) ◽

Author(s):

David T. Lai ◽

Frederick A. Tibayan ◽

Truls Myrmel ◽

Tomasz A. Timek ◽

Paul Dagum ◽

...

Keyword(s):

Mitral Regurgitation ◽

High Speed ◽

Lateral Displacement ◽

Three Dimensional ◽

Mitral Annulus ◽

Left Ventricular ◽

Ischemic Mitral Regurgitation ◽

Posterior Leaflet ◽

Mitral Leaflet ◽

Posterior Mitral Leaflet

Background Three-dimensional dynamics of the 3 individual scallops within the posterior mitral leaflet during acute ischemic mitral regurgitations have not been previously measured. Methods Radiopaque markers were sutured to the mitral annulus, papillary muscle tips, and leaflet edges in 13 sheep. Immediately postoperatively, under open-chest conditions, 3-D marker coordinates were obtained using high-speed biplane videofluoroscopy before and during echocardiographically verified acute ischemic mitral regurgitation produced by occlusion of the left circumflex coronary artery. Results During acute ischemic mitral regurgitation, at end systole, the anterolateral edge of the central scallop was displaced 0.8±0.9 mm laterally and 0.9±0.6 mm apically away from the anterolateral scallop; such displacement correlated with lateral displacement of the lateral annulus (R 2 =0.7, SEE=0.7 mm, P <0.001) and movement of the right lateral annulus away from the nonischemic anterior papillary tip (R 2 =0.6, SEE=0.8 mm, P =0.002), respectively. End-systolic displacement of the posteromedial edge of the central scallop was 1.4±0.9 mm anteriorly and 0.9±0.6 mm laterally away from the posteromedial scallop, corresponding to anterior displacement of the mid-lateral annulus (R 2 =0.5, SEE=1.0 mm, P <0.001). Conclusions Malcoaptation of the scallops within the posterior leaflet during acute left ventricular ischemia is a novel observation. The primary geometric mechanism underlying scallop malcoaptation in acute ischemic mitral regurgitation was annular dilatation, which hindered leaflet coaptation by drawing the individual scallops apart. These findings support the use of annular reduction in the repair of ischemic mitral regurgitation and also suture closure of prominent subcommissures between posterior leaflet scallops.

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Relation of Mitral Annulus and Left Atrial Dysfunction to the Severity of Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy

Cardiology Research and Practice ◽

10.1155/2020/3261714 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Sorina Mihaila Baldea ◽

Denisa Muraru ◽

Marcelo Haertel Miglioranza ◽

Sabino Iliceto ◽

Dragos Vinereanu ◽

...

Keyword(s):

Mitral Regurgitation ◽

Dilated Cardiomyopathy ◽

Three Dimensional ◽

Mitral Annulus ◽

Functional Mitral Regurgitation ◽

Contractile Dysfunction ◽

Left Atrial Dysfunction ◽

The Relationship ◽

Selection Of Patients ◽

Selection Of

Introduction and Objectives. Patients with dilated cardiomyopathy (DCM) and functional mitral regurgitation (FMR) present altered geometry and dynamics of the mitral annulus (MA). We aimed to further assess the relationship between the MA dysfunction, FMR severity, and LA dysfunction in patients with ischemic and nonischemic DCM by using three-dimensional transthoracic echocardiography (3DTTE). Methods. 56 patients (58 ± 17 years, 42 men) with DCM and FMR and 52 controls, prospectively enrolled, underwent 3DTTE dedicated for mitral valve (MV), LA, and left ventricle (LV) quantitative analysis. Results. Patients with FMR vs. controls presented increased MA size and sphericity during the entire systole, whereas MA fractional area change (MAFAC) and MA displacement were decreased (15 ± 5 vs. 28 ± 5%; and 5 ± 3 vs. 10 ± 2 mm, p<0.001). In patients with moderate/severe FMR, MA diameters correlated with PISA radius, EROA, and regurgitant volume (Rvol), as also did the MA area (with PISA radius, EROA, and Rvol: r = 0.48, r = 0.58, and r = 0.47, p<0.05). MAFAC correlated inversely with EROA and Rvol (r = −0.32 and r = −0.35, p<0.05), with both active and total LA emptying fractions and with LV ejection fraction as well. In a stepwise multivariate regression model, decreased MAFAC and increased LA volume independently predicted patients with severe FMR. Conclusions. Patients with DCM and FMR have MA geometry remodeling and contractile dysfunction, correlated with the severity of FMR. MA contractile dysfunction correlated with both LA and left LV pumps dysfunctions and predicted patients with severe FMR. Our results provide new insights that might help with better selection of patients for MV transcatheter procedures.

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