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You are here: Contents > 2012 > Volume 21 Number 6 November 2012 > MITRAL VALVE DISEASE > Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

Feroze Mahmood, Haider J. Warraich, Joseph H. Gorman III, Robert C. Gorman, Tzong-Huei Chen, Peter Panzica, Andrew Maslow, Kamal Khabbaz
Departments of Anesthesia, Critical Care, and Pain Management and Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, MA, Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, RI, USA

Background and aim of the study: Intraoperative
real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR).
Methods: A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters.
Results: Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9%, p <0.001) and the

anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 6.2%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter.
Conclusion: The mitral annulus undergoes significant geometric changes immediately after AVR. Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve.

The Journal of Heart Valve Disease 2012;21:696-701

Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

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