Dynamic changes in the ischemic mitral annulus: Implications for ring sizing
Objectives: Contrary to the rest of the mitral annulus, inter-trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annul...
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doaj-918ddb82e67f48f8ae7af2f2508469132020-11-24T20:46:47ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842016-01-01191151910.4103/0971-9784.173014Dynamic changes in the ischemic mitral annulus: Implications for ring sizingKhurram OwaisMario Montealegre-GallegosJelliffe JeganathanRobina MatyalKamal R KhabbazFeroze MahmoodObjectives: Contrary to the rest of the mitral annulus, inter-trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative three-dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab ® software. Results: Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral-posteromedial diameters and inter-trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter-trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter-trigonal distance does not change significantly during the cardiac cycle.http://www.annals.in/article.asp?issn=0971-9784;year=2016;volume=19;issue=1;spage=15;epage=19;aulast=OwaisIschemic mitral regurgitation; Mitral annulus; Mitral valve repair; Three-dimensional echocardiography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Khurram Owais Mario Montealegre-Gallegos Jelliffe Jeganathan Robina Matyal Kamal R Khabbaz Feroze Mahmood |
spellingShingle |
Khurram Owais Mario Montealegre-Gallegos Jelliffe Jeganathan Robina Matyal Kamal R Khabbaz Feroze Mahmood Dynamic changes in the ischemic mitral annulus: Implications for ring sizing Annals of Cardiac Anaesthesia Ischemic mitral regurgitation; Mitral annulus; Mitral valve repair; Three-dimensional echocardiography |
author_facet |
Khurram Owais Mario Montealegre-Gallegos Jelliffe Jeganathan Robina Matyal Kamal R Khabbaz Feroze Mahmood |
author_sort |
Khurram Owais |
title |
Dynamic changes in the ischemic mitral annulus: Implications for ring sizing |
title_short |
Dynamic changes in the ischemic mitral annulus: Implications for ring sizing |
title_full |
Dynamic changes in the ischemic mitral annulus: Implications for ring sizing |
title_fullStr |
Dynamic changes in the ischemic mitral annulus: Implications for ring sizing |
title_full_unstemmed |
Dynamic changes in the ischemic mitral annulus: Implications for ring sizing |
title_sort |
dynamic changes in the ischemic mitral annulus: implications for ring sizing |
publisher |
Wolters Kluwer Medknow Publications |
series |
Annals of Cardiac Anaesthesia |
issn |
0971-9784 |
publishDate |
2016-01-01 |
description |
Objectives: Contrary to the rest of the mitral annulus, inter-trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative three-dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab ® software. Results: Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral-posteromedial diameters and inter-trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter-trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter-trigonal distance does not change significantly during the cardiac cycle. |
topic |
Ischemic mitral regurgitation; Mitral annulus; Mitral valve repair; Three-dimensional echocardiography |
url |
http://www.annals.in/article.asp?issn=0971-9784;year=2016;volume=19;issue=1;spage=15;epage=19;aulast=Owais |
work_keys_str_mv |
AT khurramowais dynamicchangesintheischemicmitralannulusimplicationsforringsizing AT mariomontealegregallegos dynamicchangesintheischemicmitralannulusimplicationsforringsizing AT jelliffejeganathan dynamicchangesintheischemicmitralannulusimplicationsforringsizing AT robinamatyal dynamicchangesintheischemicmitralannulusimplicationsforringsizing AT kamalrkhabbaz dynamicchangesintheischemicmitralannulusimplicationsforringsizing AT ferozemahmood dynamicchangesintheischemicmitralannulusimplicationsforringsizing |
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1716811511787159552 |