Background and aim of the study: Saddle-shaped non-planarity of the mitral annulus has been investigated previously. The study aim was to further clarify the configuration of the mitral annulus in ischemic mitral regurgitation (MR) by using transthoracic real-time three-dimensional (3-D) echocardiography.
Methods: Twenty-five patients with previous myocardial infarction and left ventricular dysfunction (ejection fraction <50%), and 10 healthy control subjects, were examined using real-time 3-D transthoracic echocardiography. The patients were allocated to either a non-MR group or an MR group. By using real-time 3-D echocardiography, the configuration of the mitral annulus was reconstructed in end-systole, and the height of the saddle-shaped mitral annulus calibrated (non-planar index).
Results: In controls, the mitral annulus appeared as

non-planar ‘saddle shape’, with a non-planar index of 5.5 ± 1.7 mm. The mitral annulus was flattened in both the non-MR and MR groups. The non-planar index was significantly smaller in the MR group than in the non-MR group (1.7 ± 1.8 mm versus 3.8 ± 1.2 mm, p <0.05). The systolic annular area was significantly larger in the MR group than the non-MR group.
Conclusion: The ‘saddle shape’ of the mitral annulus was deformed in patients with ischemic MR. Mitral annulus deformation may play a role in ischemic MR in conjunction with mitral valve tenting. These results suggest that a non-planar saddle-shaped annuloplasty ring would contribute to successful mitral valve repair durability in patients with ischemic MR.


The Journal of Heart Valve Disease 2005;14:447-452