Abstract 16507: Decreased Annular Dynamic Motion in Ischemic Mitral Regurgitation: Implication for Annuloplasty Selection
Introduction: There is consensus that mitral valve repair procedures for ischemic mitral regurgitation (IMR) should employ undersized annuloplasty rings to restore normal annular area. Some surgeons employ flexible annuloplasty rings to preserve the dynamic properties of the valve. We hypothesized that mitral annular dynamics are impaired in IMR which would invalidate the justification for flexible annuloplasty devices. This study describes the dynamic parameters in normal and IMR annuli, using real-time 3D transesophageal echocardiography (rt-3DTEE) and semi-automated annular tracking.
Methods: Philips iE33 echocardiographic module and X7-2t probe were used to acquire full volume rt-3DTEE loops in 10 normal subjects and 10 patients with ischemic mitral regurgitation (IMR). Image analysis was performed using Tomtec Image Arena - 4D-MV Assessment© - 2.0 (Munich, Germany). A mid-systolic frame was selected for the initiation of annular tracking using the semi-automated program. Measured parameters were normalized in time to provide for uniform systolic and diastolic periods.
Results: Average end-diastolic 2D annular area was 6.38 ± 1.15 cm2 in normals and 9.32 ± 1.43 cm2 IMR. (p= 0.016) IMR annuli were less dynamic than normal annuli with an average 2D annular area fraction, (Area max-Area min)/Area max), of 18.49 ± 7.70 % for the control group and 10.48 ± 5.50 % for ischemic patients. (p = 0.020) Similar reduction of annular motion in IMR patients was noted for septolateral diameter, circumference, annular velocity and annular displacement. (Figure 1)
Conclusion: Patients with IMR have reduced annular contraction and motion when compared to normal controls. Flexible annuloplasty devices likely contribute little to improving valve function in IMR patients.
- © 2011 by American Heart Association, Inc.