Abstract 15625: Normalization of Mitral Annular Motion after Repair of Mitral Valve Prolapse: Geometric Quantification Using Intraoperative 3D TEE

Abstract

Introduction: Mitral valve repair is the definitive therapy for severe degenerative mitral regurgitation. Despite the effectiveness of repair, post-operative geometry and the effect of annuloplasty on mitral annular dynamics have not been fully delineated in myxomatous mitral valve disease.

Methods: Patients undergoing mitral valve repair plus annuloplasty repair for severe degenerative prolapse causing severe mitral regurgitation (n=8) were evaluated with 3-dimensional (3D) transesophageal echocardiography (TEE) pre-operatively (PRE) and post-operatively (POST). Patients undergoing non-mitral cardiac surgery with normal 2D TEE mitral valve anatomy served as Controls (n=7). Patients with left ventricular dysfunction or atrial fibrillation were excluded. 3D full volume images were analyzed off-line utilizing novel 3D valve software. Mitral annular and valvular geometric assessments were performed throughout the cardiac cycle including sequential quantification of annular height to analyze dynamic annular motion. Comparisons were made between PRE, POST, and Controls.

Results: Mitral annular area and annular height were greater in PRE vs. Controls (late systolic annular area: 14.3±4.4 cm² vs.7.6±1.2 cm², p=0.0034, early systolic annular height: 8.0±1.4mm vs. 7.2±1.4mm, p=0.0328; and mid-diastolic height: 6.0±1.06 mm vs. 4.3±0.9mm, p=0.0402). Despite this, the ratio of annular height to area was smaller in PRE vs. Control (0.5±0.1 vs. 0.8±0.3, p=0.0412). Following leaflet repair plus annuloplasty, mitral valve and annular geometric parameters were similar to Controls throughout the cardiac cycle.

Conclusions:Sequential geometric analysis of mitral valve dynamics demonstrates distortion of the annular height to annular area ratio in myxomatous mitral valve disease. Mitral leaflet repair plus annuloplasty effectively restores normal mitral annular geometry and motion which may explain the long term effectiveness of this procedure.