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Ann Thorac Surg 2001;72:966-974
© 2001 The Society of Thoracic Surgeons

Review

Experimental and clinical assessment of mitral annular area and dynamics: what are we actually measuring?

Tomasz A. Timek, MDa, D. Craig Miller, MDa

a Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA

Address reprint requests to Dr Miller, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247

The mitral annulus is an essential, dynamic, and tightly coupled component of the mitral valve/left atrial/left ventricular complex that aids in effective and efficient valve closure and unimpeded left ventricular filling. Although the dynamic nature of mitral annular motion has been studied carefully for more than 30 years, accurate measurement of mitral annular area and motion continues to be a challenge for physiologists and clinicians alike. Roentgenographic ciné imaging of radiopaque markers, sonomicrometry, magnetic resonance imaging, and two-dimensional echocardiography have all been used to evaluate mitral annular area and dynamics, yet widely disparate measurements abound. Paradoxically, newer three-dimensional transesophageal echocardiographic findings may have added to this miasma. To explore the variability of these measurements, we reviewed our experimental data as well as clinical and experimental observations reported in the literature to clarify what we are actually measuring and perhaps explain the reported disagreement. The objective was to shed some light on the possible reasons for these discordant findings.




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