Abstract 299: Geometric Comparison of the Mitral and Tricuspid Valve Annulus: Insights From 3-Dimensional Transesophageal Echocardiography
Background: Mitral annular (MVA) and tricuspid annular (TVA) geometry has been previously described. We compared three-dimensional (3D) tricuspid annular (TVA) with MVA geometry in the same patients.
Methods: MVA and TVA shape were examined by real-time 3D TEE in 30 consecutive patients with native atrioventricular valves. The 3D shape of the annuli was reconstructed using MVA model software (Philips® Qlab, MVQ Ver 6.0). Annular area, circumference, high-low distances (H-LD), anterolateral-posteriomedial (AlPm) and anteroposterior (AP) axes were measured and compared.
Results: Both the MVA and TVA have bimodal pattern with significantly different heights (MVA: high-low distance=9.61±2.09 mm, TVA: high-low distance=4.85±1.69 mm, p< 0.0001). MVA was rounder than TVA (MVA AlPm-AP ratio = 1.06, p=0.02, TVA AlPm-AP ratio=1.10, p<0.001), though both showed similar annular area (MVA: 1095.8±314.5 mm2, TVA: 1117.3±316.2 mm2, p=0.66), circumference (MVA: 128.0±19.7 mm, TVA: 125.9±16.5 mm, p=0.36), AlPm axis (MVA: 37.4±6.9 mm, TVA: 37.9±5.9 mm, p=0.67), and AP axis (MVA: 35.3±5.3 mm, TVA: 34.3±5.9 mm, p=0.34).
Conclusions: The MVA and TVA have distinct shapes. The MVA is more elevated and circular while the TVA is more planar and ovoid (Figure 1⇓). These differences may be due to the intravalvular fibrosa between the anterior mitral leaflet and the right coronary aortic leaflet. These differences need further evaluation in disease states such as hypertrophic obstructive cardiomyopathy and pulmonary hypertension.