Skip to main content
SpringerLink
Log in

Impact of different annuloplasty rings on geometry of the mitral annulus with fibroelastic deficiency: the significance of aorto–mitral angle

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

We sought to investigate the impact of full annuloplasty rings versus C-shape bands on mitral annular geometry in the presence of fibroelastic deficiency (FED), as assessed by intraoperative three-dimensional transesophageal echocardiography (3DTEE). We retrospectively selected 65 patients who underwent mitral valve repair for severe mitral regurgitation caused by FED using full rings (the Ring group, n = 30) and C-shape bands (the Band group, n = 35). 71 controls without valvular heart disease were also included. Thorough 3DTEE inspections were performed for the entire cohort to measure morphological parameters of mitral annulus before and after surgery. Mid-term repair durability and left atrial diameter were followed up. The preoperative 3DTEE parameters, including annular diameters, area, height and aorto–mitral angle, were significantly larger in the FED groups than normal, and were comparable between two groups using different annuloplasty devices. After repair, the anterior–posterior diameter, annulus circumference and area were significantly larger in the Band group than in the Ring group. The aorto–mitral angle became comparable with normal value in the Ring group (p = 0.728), but not in the Band group (p = 0.011). Follow-up echocardiographic data showed a significant correlation between postoperative aorto–mitral angle and reduced left atrial diameter at 50.3 months after surgery (r = 0.63; p < 0.001). In conclusion, compared with C-shape bands, full rings may impose less narrowing on aorto–mitral angle, which correlates well with mid-term left atrial reverse remodeling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 148:e1–e132

    Article  Google Scholar 

  2. Murashita T, Okada Y, Kanemitsu H et al (2015) Long-term outcomes after mitral valve repair for degenerative mitral regurgitation with persistent atrial fibrillation. Thorac Cardiovasc Surg 63:243–249

    PubMed  Google Scholar 

  3. Bothe W, Kvitting JP, Swanson JC, Hartnett S, Ingels NB Jr, Miller DC (2010) Effects of different annuloplasty rings on anterior mitral leaflet dimensions. J Thorac Cardiovasc Surg 139:1114–1122

    Article  Google Scholar 

  4. Owais K, Kim H, Khabbaz KR et al (2014) In-vivo analysis of selectively flexible mitral annuloplasty rings using three-dimensional echocardiography. Ann Thorac Surg 97:2005–2010

    Article  Google Scholar 

  5. Chang BC, Youn YN, Ha JW, Lim SH, Hong YS, Chung N (2007) Long-term clinical results of mitral valvuloplasty using flexible and rigid rings: a prospective and randomized study. J Thorac Cardiovasc Surg 133:995–1003

    Article  Google Scholar 

  6. Gripari P, Mapelli M, Bellacosa I et al (2018) Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-018-1324-2

    Article  PubMed  Google Scholar 

  7. van Wijngaarden SE, Kamperidis V, Regeer MV et al. Three-dimensional assessment of mitral valve annulus dynamics and impact on quantification of mitral regurgitation. Eur Heart J Cardiovasc Imaging https://doi.org/10.1093/ehjci/jex001

    Article  Google Scholar 

  8. Elmistekawy E, Mesana T, Chan V (2013) Ischemic mitral regurgitation: current trends and treatment. Curr Opin Cardiol 28:661–665

    Article  Google Scholar 

  9. Chan KL, Chen SY, Chan V, Hay K, Mesana T, Lam BK (2013) Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation. Circ Cardiovasc Imaging 6:1041–1047

    Article  Google Scholar 

  10. Varghese R, Itagaki S, Anyanwu AC, Trigo P, Fischer G, Adams DH (2014) Predicting systolic anterior motion after mitral valve reconstruction: using intraoperative transoesophageal echocardiography to identify those at greatest risk. Eur J Cardiothorac Surg 45:132–137 (discussion 137–138)

    Article  Google Scholar 

  11. Nishi H, Toda K, Miyagawa S et al (2016) Annular dynamics after mitral valve repair with different prosthetic rings: a real-time three-dimensional transesophageal echocardiography study. Surg Today 46:1083–1090

    Article  Google Scholar 

  12. Calleja A, Poulin F, Woo A et al (2015) Quantitative modeling of the mitral valve by three-dimensional transesophageal echocardiography in patients undergoing mitral valve repair: correlation with intraoperative surgical technique. J Am Soc Echocardiogr 28:1083–1092

    Article  Google Scholar 

  13. Grewal J, Suri R, Mankad S et al (2010) Mitral annular dynamics in myxomatous valve disease: new insights with real-time 3-dimensional echocardiography. Circulation 121:1423–1431

    Article  Google Scholar 

  14. Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802

    Article  Google Scholar 

  15. Lee AP, Jin CN, Fan Y, Wong RHL, Underwood MJ, Wan S (2017) Functional implication of mitral annular disjunction in mitral valve prolapse: a quantitative dynamic 3D echocardiographic study. JACC Cardiovasc Imaging 10:1424–1433

    Article  Google Scholar 

  16. Caiani EG, Fusini L, Veronesi F et al (2011) Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up. Eur J Echocardiogr 12:375–383

    Article  Google Scholar 

  17. Levack MM, Jassar AS, Shang EK et al (2012) Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection. Circulation 126:S183–S188

    Article  Google Scholar 

  18. Rohm I, Poerner TC, Hamadanchi A et al (2017) Quantification of mitral regurgitation during percutaneous mitral valve repair: added value of simultaneous hemodynamic and 3D echocardiographic assessment. Int J Cardiovasc Imaging 33:1531–1539

    Article  Google Scholar 

  19. Veronesi F, Caiani EG, Sugeng L et al (2012) Effect of mitral valve repair on mitral-aortic coupling: a real-time three-dimensional transesophageal echocardiography study. J Am Soc Echocardiogr 25:524–531

    Article  Google Scholar 

  20. Witschey WR, Zhang D, Contijoch F et al (2015) The influence of mitral annuloplasty on left ventricular flow dynamics. Ann Thorac Surg 100:114–121

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by three institutional grants from Shanghai Chest Hospital (2014YZDH10301 to Dr. WW, 2014YZDH10302 and YZ2015-ZX03 to Dr. WZ) and one grant from Shanghai Municipal Commission of Health and Family Planning (201540309 to Dr. WY). Additionally, we thank Mr. Xinyu Ma, MS, for statistical consulting.

Author information

Author notes

  1. Wenrui Ma and Wei Ye have contributed equally to this study.

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihaixi Rd, Shanghai, 200030, China

    Wenrui Ma, Wei Ye, Jing Zhang, Wei Zhang & Ye Kong

  2. Department of Echocardiography, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihaixi Rd, Shanghai, 200030, China

    Weihua Wu

Authors
  1. Wenrui Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Weihua Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ye Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Wei Zhang or Weihua Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, W., Ye, W., Zhang, J. et al. Impact of different annuloplasty rings on geometry of the mitral annulus with fibroelastic deficiency: the significance of aorto–mitral angle. Int J Cardiovasc Imaging 34, 1707–1713 (2018). https://doi.org/10.1007/s10554-018-1383-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1383-4

Keywords

Search

Navigation