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a Department of Anesthesia and Critical Care and Pain Management, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
b Cardiovascular Institute, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
c Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
d Gorman Cardiovascular Research Group, Glenoldan Research Laboratory, University of Pennsylvania, Glenoldan, Pennsylvania
Accepted for publication July 2, 2009.
* Address correspondence to Dr Mahmood, Vascular Anesthesia and Perioperative Echocardiography, Department of Anesthesia and Critical Care, CC-470, Deaconess 1 (West Campus), Beth Israel Deaconess Medical Center, Boston MA 02215 (Email: fmahmood{at}bidmc.harvard.edu).
Background: Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair.
Methods: We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared.
Results: Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 ± 14 versus 146 ± 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings.
Conclusions: Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity.
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