Quantitative Modeling of the Mitral Valve by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Mitral Valve Repair: Correlation with Intraoperative Surgical Technique.
BACKGROUND
Mitral valve (MV) repair is the procedure of choice for patients with degenerative MV disease (DMVD) with severe mitral regurgitation. The aim of this study was to identify specific quantitative MV parameters from preoperative three-dimensional (3D) transesophageal echocardiography that are associated with the length of the mitral annuloplasty band implanted and the performance of leaflet resection in patients with DMVD undergoing MV repair.


METHODS
Ninety-four patients (mean age, 60 ± 11 years; 68% men) referred for MV surgery with adequate-quality preoperative 3D transesophageal echocardiographic studies were retrospectively identified. Parametric maps of the MV were generated using semiautomated MV modeling software. Annular and valvular parameters were measured and indexed to body surface area. The implanted annuloplasty band size and leaflet resection were determined on the basis of surgical reports.


RESULTS
Three-dimensional annular circumference correlated best (r = 0.74) with the implanted annuloplasty band length and remained an independent predictor on multivariate linear regression analysis. A third of our cohort (n = 33) had posterior leaflet resection. On receiver operating characteristic curve analysis, P2 segment length ≥ 20 mm (area under the curve, 0.86; sensitivity, 88%; specificity, 74%) and P2 leaflet area ≥ 3.4 cm(2) (area under the curve, 0.84; sensitivity, 85%; specificity, 74%) best discriminated the need for leaflet resection.


CONCLUSIONS
In DMVD, quantitative 3D annular circumference obtained from semiautomatically generated parametric maps of the MV from 3D transesophageal echocardiographic data was associated with the surgically implanted annuloplasty band length, while P2 leaflet length ≥ 20 mm and area ≥ 3.4 cm(2) were associated with the performance of leaflet resection. These parameters should be further investigated for preoperative planning in patients with DMVD undergoing MV repair.
['Calleja|Anna|A|', 'Poulin|Frédéric|F|', 'Woo|Anna|A|', 'Meineri|Massimiliano|M|', 'Jedrzkiewicz|Sean|S|', 'Vannan|Mani A|MA|', 'Rakowski|Harry|H|', 'David|Tirone|T|', 'Tsang|Wendy|W|', 'Thavendiranathan|Paaladinesh|P|']
D019560:Echocardiography, Three-Dimensional D017548:Echocardiography, Transesophageal D005260:Female D005500:Follow-Up Studies D006801:Humans D007432:Intraoperative Period D008297:Male D008875:Middle Aged D008943:Mitral Valve D058386:Mitral Valve Annuloplasty D008944:Mitral Valve Insufficiency D012372:ROC Curve D015203:Reproducibility of Results D012189:Retrospective Studies D016896:Treatment Outcome
Three-dimensional transesophageal echocardiography Annuloplasty Leaflet resection Degenerative mitral valve disease Quantitative valve modeling