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Sizing of mitral annuloplasty rings using real-time three-dimensional transesophageal echocardiography and the difference between patients with and without recurrent mitral regurgitation: retrospective cohort study

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Abstract

Background

Previous studies showed that the mitral inter-commissural (IC) distance differed by a few millimeters between the systolic and diastolic cardiac cycles. However, sizing of the mitral annuloplasty ring with a ring sizer, which should be performed in the systole, is performed in diastole during hyperkalemic cardioplegic arrest. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography (3D-TEE) measurements of the mitral valve in end-systole are effective to determine the size of the annuloplasty ring.

Methods

This study retrospectively reviewed 92 patients who underwent mitral annuloplasty for degenerative. The IC distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systole. The annuloplasty ring size was measured by the surgeons using specific ring sizers. We compared the IC distance measured by 3D-TEE with the implanted annuloplasty size. We also investigated differences in IC distance, A2 height, and ratio of A2 height to IC distance in patients with and without recurrent mild to moderate MR for 36 months.

Results

There was a significant correlation between the IC distance by 3D-TEE and the implanted ring size (R2 = 0.7023, p < 0.001). Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059).

Conclusions

Our results demonstrated a larger ratio of A2 height to IC distance in patients with recurrent MR. 3D-TEE could be useful for the ring sizing.

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Funding

Funding was provided by Department fundings (Grant No. Basic-9)

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Authors and Affiliations

  1. Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan

    Tasuku Fujii, Kenji Yoshitani, Eiki Kanemaru & Yoshihiko Ohnishi

  2. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan

    Tasuku Fujii & Kimitoshi Nishiwaki

  3. Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan

    Michikazu Nakai & Kunihiro Nishimura

Authors
  1. Tasuku Fujii
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  2. Kenji Yoshitani
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  3. Eiki Kanemaru
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  4. Michikazu Nakai
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  5. Kunihiro Nishimura
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  6. Yoshihiko Ohnishi
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  7. Kimitoshi Nishiwaki
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Corresponding author

Correspondence to Kenji Yoshitani.

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Conflict of interest

Tasuku Fujii, Kenji Yoshitani, Eiki Kanemaru, Michikazu Nakai, Kunihiro Nishimura, Yoshihiko Ohnishi, and Kimitoshi Nishiwaki declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

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Informed consent was obtained from all patients for being included in this study.

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Fujii, T., Yoshitani, K., Kanemaru, E. et al. Sizing of mitral annuloplasty rings using real-time three-dimensional transesophageal echocardiography and the difference between patients with and without recurrent mitral regurgitation: retrospective cohort study. J Echocardiogr 18, 169–174 (2020). https://doi.org/10.1007/s12574-020-00465-x

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  • DOI: https://doi.org/10.1007/s12574-020-00465-x

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