Quantitative Analysis of Mitral Valve Apparatus in Mitral Valve Prolapse Before and After Annuloplasty: A Three-Dimensional Intraoperative Transesophageal Study

• Published in: Journal of the American Society of Echocardiography Vol. 24; no. 4; pp. 405 - 413
• Main Authors: Maffessanti, Francesco, MS, Marsan, Nina A., MD, Tamborini, Gloria, MD, Sugeng, Lissa, MD, Caiani, Enrico G., PhD, Gripari, Paola, MD, Alamanni, Francesco, MD, Jeevanandam, Valluvan, MD, Lang, Roberto M., MD, Pepi, Mauro, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.04.2011
• Subjects: Analysis of Variance; Cardiovascular; Case-Control Studies; Degenerative mitral valve prolapse; Echocardiography, Three-Dimensional - methods; Female; Humans; Image Interpretation, Computer-Assisted; Intraoperative Period; Intraoperative real-time 3D echocardiography; Male; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - pathology; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - pathology; Mitral Valve Prolapse - surgery; Mitral valve repair; Software; Statistics, Nonparametric; BD; Mitral valve; Transesophageal echocardiography; FED; Barlow’s disease; MR; Degenerative mitral valve prolapse; Left ventricular; Two-dimensional; MV; Mitral valve repair; Fibroelastic deficiency; LV; 3D; 2D; Three-dimensional; RT3D; TEE; Mitral regurgitation; Real-time three-dimensional; Intraoperative real-time 3D echocardiography
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2011.01.012

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 cm2 in FED and 15.4 ± 3.8 cm2 in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm2 ), 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 cm2 in FED, 4.9 ± 1.3 cm2 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.