Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty

A three-dimensional intraoperative transesophageal study

Francesco Maffessanti, Nina A. Marsan, Gloria Tamborini, Lissa Sugeng, Enrico G. Caiani, Paola Gripari, Francesco Alamanni, Valluvan Jeevanandam, Roberto M. Lang, Mauro Pepi

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning. Methods: Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software. Results: MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm 2 in FED and 15.4 ± 3.8 cm 2 in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm 2), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm 2 in FED, 4.9 ± 1.3 cm 2 in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery. Conclusions: Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.

Original languageEnglish
Pages (from-to)405-413
Number of pages9
JournalJournal of the American Society of Echocardiography
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 2011

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Mitral Valve Prolapse
Mitral Valve
Three-Dimensional Echocardiography
Transesophageal Echocardiography
Mitral Valve Annuloplasty
Anatomy
Software
Deficiency Diseases
Aortic Diseases
Mitral Valve Insufficiency
Coronary Artery Bypass
Reference Values
Control Groups

Keywords

  • Degenerative mitral valve prolapse
  • Intraoperative real-time 3D echocardiography
  • Mitral valve repair

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty : A three-dimensional intraoperative transesophageal study. / Maffessanti, Francesco; Marsan, Nina A.; Tamborini, Gloria; Sugeng, Lissa; Caiani, Enrico G.; Gripari, Paola; Alamanni, Francesco; Jeevanandam, Valluvan; Lang, Roberto M.; Pepi, Mauro.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 4, 04.2011, p. 405-413.

Research output: Contribution to journalArticle

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title = "Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty: A three-dimensional intraoperative transesophageal study",
abstract = "Background: Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning. Methods: Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software. Results: MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm 2 in FED and 15.4 ± 3.8 cm 2 in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm 2), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm 2 in FED, 4.9 ± 1.3 cm 2 in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery. Conclusions: Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.",
keywords = "Degenerative mitral valve prolapse, Intraoperative real-time 3D echocardiography, Mitral valve repair",
author = "Francesco Maffessanti and Marsan, {Nina A.} and Gloria Tamborini and Lissa Sugeng and Caiani, {Enrico G.} and Paola Gripari and Francesco Alamanni and Valluvan Jeevanandam and Lang, {Roberto M.} and Mauro Pepi",
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T1 - Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty

T2 - A three-dimensional intraoperative transesophageal study

AU - Maffessanti, Francesco

AU - Marsan, Nina A.

AU - Tamborini, Gloria

AU - Sugeng, Lissa

AU - Caiani, Enrico G.

AU - Gripari, Paola

AU - Alamanni, Francesco

AU - Jeevanandam, Valluvan

AU - Lang, Roberto M.

AU - Pepi, Mauro

PY - 2011/4

Y1 - 2011/4

N2 - Background: Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning. Methods: Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software. Results: MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm 2 in FED and 15.4 ± 3.8 cm 2 in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm 2), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm 2 in FED, 4.9 ± 1.3 cm 2 in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery. Conclusions: Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.

AB - Background: Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning. Methods: Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software. Results: MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm 2 in FED and 15.4 ± 3.8 cm 2 in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm 2), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm 2 in FED, 4.9 ± 1.3 cm 2 in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery. Conclusions: Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.

KW - Degenerative mitral valve prolapse

KW - Intraoperative real-time 3D echocardiography

KW - Mitral valve repair

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