European Journal of Echocardiography Advance Access originally published online on May 13, 2008
European Journal of Echocardiography 2009 10(1):74-81; doi:10.1093/ejechocard/jen165
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography
1 Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA
2 Division of Cardiothoracic Surgery, Ohio State University Medical Center, Columbus, OH 43210, USA
3 Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus, OH 43210, USA
Received 21 October 2007; accepted after revision 20 April 2008; online publish-ahead-of-print 13 May 2008.
* Corresponding author. Tel: +1 610 996 5345/+1 614 293 7277. E-mail address: rashmi_vandse{at}yahoo.com
 |
Abstract |
|---|
Aims: Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient’s functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform® annuloplasty ring using three-dimensional (3D) echocardiography.
Methods and results: Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4 ± 0.2 to 0.9 ± 0.3 (P-value < 0.0001), mitral valve tenting volume from 13 ± 1.7 to 3.2 ± 0.3 mL (P-value < 0.001), annulus area from 12.6 ± 1.0 to 3.3 ± 0.2 cm2 (P-value < 0.0001), valve circumference from 13 ± 0.5 to 7.3 ± 0.3 cm (P-value < 0.0001), septolateral distance from 2.1 ± 0.1 to 1.4 ± 0.06 cm (P-value < 0.01) and intercommissural distance from 3.4 ± 0.1 to 2.7 ± 0.03 cm (P-value < 0.03). There was significant decrease in the septolateral distance at the level of A2–P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1 ± 0.3 to 1.3 ± 0.3 (P-value < 0.002).
Conclusion: The mitral valve annuloplasty with the Geoform® ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry.
Keywords: Annuloplasty; Ischaemic mitral regurgitation; Mitral valve; Mitral valve tenting; Three-dimensional echocardiography