HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Masashi Komeda D. Craig Miller Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Glasson, J. R. Articles by Miller, D. C. Search for Related Content PubMed PubMed Citation Articles by Glasson, J. R. Articles by Miller, D. C. Related Collections Related Article

Ann Thorac Surg 1996;62:1059-1067
© 1996 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Three-Dimensional Dynamics of the Canine Mitral Annulus During Ischemic Mitral Regurgitation

Department of Cardiovascular and Thoracic Surgery and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford; and Cardiac Surgery and Cardiology Sections, Department of Veterans Affairs Medical Center, and Department of Cardiovascular Physiology and Biophysics, Research Institute of the Palo Alto Medical Foundation, Palo Alto, California

Background. It has been suggested that ischemic mitral regurgitation results, at least in part, from generalized end-systolic mitral annulus (MA) dilatation, but the role of the MA is incompletely understood and the segmental dynamics of the MA during left ventricular ischemia have not been described.

Methods. We used radiopaque markers and simultaneous biplane videofluoroscopy to measure three-dimensional in vivo lengths of eight MA segments in 7 sedated dogs before and after induction of ischemic MR (produced by circumflex coronary artery balloon occlusion and verified by Doppler echocardiography). As viewed from the left atrium, the MA segment between markers 1 and 2 (S₁₂) was defined as starting at the posteromedial commissure, and remaining segments were numbered sequentially clockwise around the MA (ie, the posterior MA encompassed S₁₂, S₂₃, S₃₄, S₄₅; the anterior MA included S₅₆, S₆₇, S₇₈, S₈₁). Marker images obtained 7 to 12 days after implantation were used to construct x, y, and z coordinates of each marker at end-diastole and end-systole.

Results. During regional (posterolateral walls) left ventricular ischemia, the end-systolic MA area increased (4.9 ± 0.8 cm² [control] versus 5.9 ± 0.6 cm²; p = 0.005). End-systolic MA segment lengths were as follows (control, ischemia [mm, mean ± standard deviation]): S₁₂ = 9 ± 2, 10 ± 3; S₂₃ = 10 ± 2, 12 ± 3; S₃₄ = 13 ± 1, 15 ± 1; S₄₅ = 8 ± 2, 9 ± 2; S₅₆ = 11 ± 2, 11 ± 2; S₆₇ = 12 ± 2, 12 ± 2; S₇₈ = 10 ± 3, 11 ± 2; and S₈₁ = 11 ± 1, 12 ± 1. Values for S₁₂, S₂₃, S₃₄, and S₈₁ were significant (p 0.05 for control versus ischemia by paired t test).

Conclusions. During ischemic mitral regurgitation, the MA enlarged at end-systole, but in an asymmetric manner; most posterior annular segments lengthened, whereas most anterior annular segment lengths did not change. These data suggest that alterations in regional MA mechanics may be important in the pathogenesis of ischemic mitral regurgitation. Further three-dimensional studies of MA dynamics and shape should be conducted so that new knowledge may result in improved mitral valve surgical techniques.

Related Article

Discussion
Ann. Thorac. Surg. 1996 62: 1067-1068. [Extract] [Full Text]

This article has been cited by other articles:

				W. Bothe, T. C. Nguyen, M. E. Roberts, T. A. Timek, A. Itoh, N. B. Ingels Jr., and D. C. Miller Presystolic mitral annular septal-lateral shortening is independent from left atrial and left ventricular contraction during acute volume depletion Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 236 - 243. [Abstract] [Full Text] [PDF]

				J. Kwan, G.-C. Kim, M.-J. Jeon, D.-H. Kim, T. Shiota, J. D. Thomas, K.-S. Park, and W.-H. Lee 3D geometry of a normal tricuspid annulus during systole: A comparison study with the mitral annulus using real-time 3D echocardiography Eur J Echocardiogr, October 1, 2007; 8(5): 375 - 383. [Abstract] [Full Text] [PDF]

				C. Coghlan and J. Hoffman Leonardo da Vinci's flights of the mind must continue: cardiac architecture and the fundamental relation of form and function revisited Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S4 - S17. [Abstract] [Full Text] [PDF]

				J. X. Qin, T. Shiota, H. Tsujino, G. Saracino, R. D. White, N. L. Greenberg, J. Kwan, Z. B. Popovic, D. A. Agler, W. J. Stewart, et al. Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimensional echocardiography and magnetic resonance imaging studies Eur J Echocardiogr, December 1, 2004; 5(6): 407 - 415. [Abstract] [Full Text] [PDF]

				L. M. Parish, B. M. Jackson, Y. Enomoto, R. C. Gorman, and J. H. Gorman III The Dynamic Anterior Mitral Annulus Ann. Thorac. Surg., October 1, 2004; 78(4): 1248 - 1255. [Abstract] [Full Text] [PDF]

				J. H. Gorman III, B. M. Jackson, S. L. Moainie, Y. Enomoto, and R. C. Gorman Influence of inotropy and chronotropy on the mitral valve sphincter mechanism Ann. Thorac. Surg., March 1, 2004; 77(3): 852 - 857. [Abstract] [Full Text] [PDF]

				F. Torrent-Guasp, M. J. Kocica, A. Corno, M. Komeda, J. Cox, A. Flotats, M. Ballester-Rodes, and F. Carreras-Costa Systolic ventricular filling Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 376 - 386. [Abstract] [Full Text] [PDF]

				F. A. Tibayan, F. Rodriguez, F. Langer, M. K. Zasio, L. Bailey, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications Ann. Thorac. Surg., November 1, 2003; 76(5): 1549 - 1555. [Abstract] [Full Text] [PDF]

				J. Kwan, T. Shiota, D. A. Agler, Z. B. Popovic, J. X. Qin, M. A. Gillinov, W. J. Stewart, D. M. Cosgrove, P. M. McCarthy, and J. D. Thomas Geometric Differences of the Mitral Apparatus Between Ischemic and Dilated Cardiomyopathy With Significant Mitral Regurgitation: Real-Time Three-Dimensional Echocardiography Study Circulation, March 4, 2003; 107(8): 1135 - 1140. [Abstract] [Full Text] [PDF]

				Y. Otsuji, T. Kumanohoso, S. Yoshifuku, K. Matsukida, C. Koriyama, A. Kisanuki, S. Minagoe, R. A. Levine, and C. Tei Isolated annular dilation does not usually cause important functional mitral regurgitation: Comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1651 - 1656. [Abstract] [Full Text] [PDF]

				G. R. Green, P. Dagum, J. R. Glasson, G. T. Daughters, A. F. Bolger, L. E. Foppiano, G. J. Berry, N. B. Ingels Jr, and D. C. Miller Mitral Annular Dilatation and Papillary Muscle Dislocation Without Mitral Regurgitation in Sheep Circulation, November 9, 1999; 100 (2009): II-95 - II-102. [Abstract] [Full Text] [PDF]

				M. Enriquez-Sarano, A.-J. Basmadjian, A. Rossi, K. R. Bailey, J. B. Seward, and A. J. Tajik Progression of mitral regurgitation: A prospective Doppler echocardiographic study J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1137 - 1144. [Abstract] [Full Text] [PDF]

				J. R. Glasson, M. Komeda, G. T. Daughters, A. F. Bolger, M. O. Karlsson, L. E. Foppiano, M. Hayase, S. N. Oesterle, N. B. Ingels Jr., and D. C. Miller Early systolic mitral leaflet "loitering" during acute ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., August 1, 1998; 116(2): 193 - 205. [Abstract] [Full Text] [PDF]