Objectives
Ischemic remodeling of the left ventricle in patients with coronary artery disease
(CAD) results in geometric changes of the mitral valve (MV) apparatus, leading to
reduced MV leaflet coaptation. Although the calculation of the coaptation area has
value in assessing the effects of left ventricular remodeling on the MV, it is difficult
and time-consuming to measure. In this study the authors hypothesized that the tenting
volume (TV) would have a greater association with coaptation area than tenting height
(TH) or tenting area (TA).
Design
A retrospective review.
Setting
A single tertiary-care academic hospital.
Participants
There were 145 adult patients who underwent coronary artery bypass graft surgery between
April 2018 and July 2020.
Measurements and Main Results
Intraoperative 2- and 3-dimensional transesophageal echocardiographic studies were
obtained in the precardiopulmonary bypass period. Offline analysis was used to obtain
TH, TA, TV and coaptation area for each patient. Correlation between the coaptation
area and the TH, TA, and TV was conducted using Pearson's correlation. The median
age of the population was 68.0 years (61.0-73.3), the body mass index was 29.0 kg/m2 (25.7-33.5), and 17.8% were females. Increases in TV were the most reliable predictor
of decreases in coaptation area (R2 = 0.75) followed by TA (R2 = 0.48) and TH (R2 = 0.47).
Conclusion
As a representative of the complete topography of the MV, the authors’ study demonstrated
that in patients with CAD, TV has a greater negative correlation with coaptation area
as compared to TH or TA.
Graphical abstarct
Graphical Abstract
Key Words
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References
- Ischemic mitral regurgitation: Mechanisms and echocardiographic classification.Eur J Echocardiogr. 2008; 9: 207-221
- A quantitative approach to the intraoperative echocardiographic assessment of the mitral valve for repair.Anesth Analg. 2015; 121: 34-58
- Dynamic 3-dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation.Ann Thorac Surg. 2013; 95: 105-110
- Regional heterogeneity in the mitral valve apparatus in patients with ischemic mitral regurgitation.Ann Thorac Surg. 2017; 103: 1171-1177
- Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.J Am Soc Echocardiogr. 2017; 30: 303-371
- Quantitative assessment of mitral valve coaptation using three-dimensional transesophageal echocardiography.Ann Thorac Surg. 2014; 97: 1998-2004
- Assessment of the mitral valve coaptation zone with 2D and 3D transesophageal echocardiography before and after mitral valve repair.J Thorac Dis. 2018; 10: 283-290
- Chronic ischemic mitral regurgitation.J Heart Valve Dis. 2006; 15: 149-157
- Tenting volume: Three-dimensional assessment of geometric perturbations in functional mitral regurgitation and implications for surgical repair.J Heart Valve Dis. 2007; 16: 1-7
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Quantitative measurement of mitral valve coaptation in functional mitral regurgitation: In vivo experimental study by real-time three-dimensional echocardiography.J Cardiol. 2009; 53: 94-101
- Cardiac remodeling—concepts and clinical implications: A consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling.J Am Coll Cardiol. 2000; 35: 569-582
- Analysis of the mitral coaptation zone in normal and functional regurgitant valves.Ann Thorac Surg. 2010; 89: 1158-1161
Article info
Publication history
Published online: October 10, 2022
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December 19, 2022
Geometric Indices for Predicting Ischemic Mitral Regurgitation: Correlation of Mitral Valve Coaptation Area With Tenting Height, Tenting Area and Tenting Volume
Geometric Indices for Predicting Ischemic Mitral Regurgitation: Correlation of Mitral Valve Coaptation Area With Tenting Height, Tenting Area and Tenting Volume
