Three-dimensional dynamic assessment of tricuspid and mitral annuli using cardiovascular magnetic resonance

Francesco Maffessanti, Paola Gripari, Gianluca Pontone, Daniele Andreini, Erika Bertella, Saima Mushtaq, Gloria Tamborini, Laura Fusini, Mauro Pepi, Enrico G. Caiani

Research output: Contribution to journalArticlepeer-review


AimsTo explore the potentiality of cardiovascular magnetic resonance (CMR) in the quantitative evaluation of mitral valve annulus (MVA) and tricuspid valve annulus (TVA) morphology and dynamics.Methods and resultsCMR was performed in 13 normal subjects and 9 patients with mitral (n = 7) or tricuspid regurgitation (n = 2), acquiring cine-images in 18 radial long-axis planes passing through the middle of MVA or TVA. A novel algorithm was used to obtain dynamic three-dimensional (3D) reconstruction of MVA and TVA. Analysis was feasible in all cases, allowing accurate 3D annular reconstruction and tracking. The 3D area increased from systole [MVA, median = 10.0 cm2 (first quartile = 8.6, third quartile = 11.4); TVA, 11.2 cm2 (8.8-13.2)] to diastole [MVA, 10.6 cm2 (9.4, 11.7); TVA, 11.9 cm2 (9.2-13.5)], with TVA larger than MVA. While the longest diameter showed similar systolic and diastolic values, the shortest diameter elongated from systole [MVA, 30 mm (29-33); TVA, 33 mm (31-36)] to diastole [MVA, 31 mm (29-32); TVA, 36 mm (33-39)]. Also, TVA became more circular than MVA. TVA showed lower peak systolic excursion in the septal [15.9 mm (13.0-18.5)] and anterior regions [17.9 mm (12.2-20.7)] compared with the posterior [21.9 mm (18.6-24.0)] segment. Values in MVA were smaller than in TVA, slightly higher in anterior [11.2 mm (9.5-13.0)] than in posterior [12.4 mm (10.2-14.6)] segments. Valvular regurgitation was associated with enlarged, flattened, and more circular annuli.ConclusionThe applied method was feasible and accurate in normal and regurgitant valves, and may potentially have an impact on diagnosis, improvement of surgical techniques and design of annular prostheses.

Original languageEnglish
Pages (from-to)986-995
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number10
Publication statusPublished - Oct 2013


  • Annular geometry
  • Cardiovascular magnetic resonance
  • Mitral valve annulus
  • Tricuspid valve annulus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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