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Mitral Annulus Geometry and Dynamic Motion Changes in Patients With Aortic Regurgitation: A Three-Dimensional Transesophageal Echocardiographic Study

  • Qinglong Meng
    Affiliations
    Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Linyuan Wan
    Affiliations
    Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Fujian Duan
    Affiliations
    Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Dandan Wang
    Affiliations
    Clinical Research, Siemens Healthineers Ltd., Shanghai, China
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  • Jia Tao
    Affiliations
    Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Hao Wang
    Correspondence
    Address correspondence to Professor Hao Wang, Department of Echocardiography, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China 100037.
    Affiliations
    Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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      Objective

      The aim of the present study was to investigate the mitral annulus (MA) geometry and dynamic motion changes in patients with aortic regurgitation (AR) before and after aortic valve replacement (AVR). Moreover, the difference in the effect of the type of prosthetic aortic valve on MA was compared.

      Design

      Prospective observational study.

      Setting

      Cardiac operating room at a single hospital.

      Participants

      Eighty-two patients with isolated moderate-to-severe AR who underwent AVR. Forty patients with normal valves were enrolled as controls.

      Interventions

      None.

      Measurements and Main Results

      The MA geometry and dynamic motion throughout the cardiac cycle were evaluated semiautomatically by three-dimensional transesophageal echocardiography. The severity of functional mitral regurgitation was intraoperatively evaluated. All patients were divided into 2 groups depending on the type of prosthetic valve (mechanical valve and bioprosthetic valve groups). Before AVR, compared with the control group without AR, the AR group demonstrated larger MA dimensions and the MA geometry was flatter. The contraction fraction of the MA area, perimeter, and height during the whole cardiac cycle were larger in the AR group (p < 0.05 for all). After AVR, most MA geometric and dynamic parameters decreased and functional mitral regurgitation also improved. In the postoperative subset analyses, the mechanical valve group showed a larger contraction fraction of the MA area and perimeter than the bioprosthetic valve group (p < 0.05 for both).

      Conclusions

      The MA geometry and dynamic motion changed markedly in patients with AR. These spatial and dynamic changes were restored to a certain extent after surgical correction of the aortic valve. However, the effects produced by mechanical and bioprosthetic valves on MA were different.

      GRAPHICAL ABSTRCT

      Key Words

      Abbreviations:

      MA (Mitral Annulus), FMR (Functional Mitral Regurgitation), AR (Aortic Regurgitation), AVR (Aortic Valve Replacement), 3D-TEE (Three-dimensional Transesophageal Echocardiography)
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      Linked Article

      • Functional Mitral Regurgitation After Aortic Valve Replacement in Aortic Incompetence: Another piece to the puzzle
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 11
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          NORMAL FUNCTION of the mitral valve is known to be intimately associated with its unique geometry. This complex structure is influenced by normal left ventricular geometry and function through closely coupled ventriculo-valvular interactions.1 The developments in echocardiography have played a crucial role in the understanding of this interplay. The advent of matrix array probes and 3D echocardiography (3DE) has brought about better characterization of mitral valve dynamics and their role in the varying etiology of mitral valve disease.
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