Abstract 16502: Impact of Mitral Valve Repair on Aortic-Mitral Coupling
Background: The mitral and aortic valves (MV, AV) are coupled via fibrous tissue. Normal aortic-mitral coupling (AMC) has been described using matrix transesophageal echocardiography (mTEE). We hypothesized that AV and left ventricular (LV) function are affected by mitral valve repair (MVRe) through altered AMC. We studied changes in AMC in patients with mitral regurgitation (MR) undergoing MVRe with a flexible ring and compared them to patients without MR with normal and with reduced LV function.
Methods: MTEE (Philips iE33) studies were performed on 34 patients: 15 controls with normal MV and LV function; 10 with MR and normal LV function, studied pre- and post-MVRe; and 9 with systolic heart failure (SHF) and normal MV and AV. Custom software tracked the AV and MV annuli in 3D space throughout the cardiac cycle, allowing automated measurements of changes in MV and AV morphology, angle and motion.
Results: Patients with severe MR had larger mitral annular (MA) areas compared to controls but were similar to SHF patients. Post-MVRe, MA area was significantly smaller compared to all other groups. Aortic annular (AoA) area was significantly smaller in controls and pre-MVRe patients compared to SHF patients. Post-MVRe, AoA area was larger compared to pre-MVRe values in diastole and a similar trend was seen in systole. No intergroup difference was noted in aortic-mitral annular angle. Post-MVRe patients showed decreased MA displacement (MAD) compared to pre-MVRe, but to a lesser extent than SHF patients. A similar trend was seen compared to controls.
Conclusion: Patients with preserved LV function and severe MR have enlarged MA area and hyperdynamic MA. MVRe with a flexible ring reduces MA area and MAD. Importantly, through AMC, the presence of the mitral valve ring restricts AoA contraction. These results show for the first time that MVRe result in abnormal physiology of the aortic valve. This is important for refinement of MV reparative techniques and ring design.
- © 2010 by American Heart Association, Inc.