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(Circulation. 2005;112:I-409 – I-414.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Annular Geometry in Patients With Chronic Ischemic Mitral Regurgitation

Three-Dimensional Magnetic Resonance Imaging Study

Shuichiro Kaji, MD; Michihiro Nasu, MD; Atsushi Yamamuro, MD; Kazuaki Tanabe, MD; Kunihiko Nagai, MD; Tomoko Tani, MD; Koichi Tamita, MD; Kenichi Shiratori, MD; Makoto Kinoshita, MD; Michio Senda, MD; Yukikatsu Okada, MD; Shigefumi Morioka, MD

From the Division of Cardiology and Department of Cardiovascular Surgery (S.K., M.N., A.Y., K.Tan., K.N., T.T., K.Tam., K.S., Y.O., S.M.), Kobe General Hospital; and the Institute of Biomedical Research and Innovation (M.K., M.S.), Kobe, Japan

Correspondence to Dr Shuichiro Kaji, Division of Cardiology, Kobe General Hospital, 4-6, Minatojima-nakamachi, Chuo-ku, Kobe, Japan, 650-0046. E-mail skaji{at}kcgh.gr.jp

Background— Although animal studies showed that annular remodeling may be related to the pathogenesis of chronic ischemic mitral regurgitation (CIMR), little was known in humans. A better understanding of the precise 3D geometry of the mitral valvular-ventricular complex in CIMR is needed to devise a better surgical technique. The purpose of the study was to elucidate mitral annular geometry in patients with CIMR using cardiac MRI.

Methods and Results— Thirty-eight patients with previous inferior or posterior myocardial infarction were studied. With the 3D reconstruction of the mitral annulus and subvalvular apparatus from a series of longitudinal cine MRIs, end-systolic mitral annulus dimensions and 3D geometry were calculated. Patients were grouped by mitral regurgitation grade using echocardiography (2+, n=15 versus 1+, n=23). Both septal-lateral and commissure-commissure mitral annular diameters were significantly greater in CIMR(+) patients (35±5 versus 30±4 mm, P=0.005; 46±6 versus 39±4 mm, P<0.001, respectively). The length of the fibrous annulus was significantly larger in CIMR(+) patients (28±3 versus 24±3 mm; P<0.001). The height of the annular "saddle horn" above a best-fit plane was lower in CIMR(+) patients (4.2±1.2 versus 6.0±1.8 mm; P=0.002), and the annular height to commissural width ratio was significantly lower in CIMR(+) patients (12±3 versus 21±5%; P<0.001).

Conclusions— Patients with CIMR had greater septal-lateral and commissure-commissure mitral annular dimension, larger intertrigonal distance, and flattened saddle shape of mitral annulus. These associated geometric alterations may be important in the pathogenesis of CIMR.

Key Words: coronary disease • ischemia • magnetic resonance imaging • mitral valve • regurgitation