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JCU 2017 June;25(2) :47-56.
Published online 2017 June 30. doi:https://doi.org/10.4250/jcu.2017.25.2.47
Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography
Eun Jeong Cho, MD, PhD1,2, Sung-Ji Park, MD, PhD1, Ga Yeon Lee, MD, PhD1, Eun Kyoung Kim, MD, PhD1, Sung-A Chang, MD, PhD1, Jin-Oh Choi, MD, PhD1, Sang-Chol Lee, MD, PhD1, Seung Woo Park, MD, PhD1, and Pyo Won Park, MD, PhD3
1Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Korea
3Department of Thoracic Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: Sung-Ji Park ,Tel: +82-2-3410-0887, Fax: +82-2-3410-3849, Email: tyche.park@gmail.com
ABSTRACT
Background:
The extent of mitral annular (MA) remodeling and dysfunction is correlated with the severity of mitral regurgitation (MR) as well as left atrial (LA) and left ventricular (LV) dilation. MA dysfunction may be a useful prognostic factor for operative timing and MR recurrence after successful mitral valve (MV) repair. The aim of this study was to evaluate additive prognostic factors of MA non-planarity using real-time 3D transesophageal echocardiography (RT3D-TEE) analysis in patients with chronic severe MR and preserved LV systolic function.
Methods:
Forty-seven patients with chronic severe MR and preserved LV systolic function scheduled for MV repair were prospectively enrolled. Echocardiographic studies were performed before surgery and postoperatively within 2 weeks and at least 6 months after surgery. RT3D-TEE was performed before the operation and immediately post-operative.
Results:
Mean age was 55.4 ± 15.1 years and 24 were male. Annulus height/body surface area (BSA) obtained via RT3D-TEE was correlated with the degree of postoperative LA remodeling. Patients were divided into two groups by average baseline annulus height/BSA. Patients with normal annular height had a smaller postoperative LV end-diastolic dimension, LV end-systolic dimension and LA volume index than patients with decreased annular height. Preoperative annulus height/BSA values strongly predicted postoperative LA remodeling.
Conclusion:
MA height may be a useful prognostic factor for determining the timing of surgery in patients with chronic primary MR. Annulus height/BSA assessed via RT3D-TEE may provide additional information predictive of postoperative LA remodeling after successful MV repair.
Keywords: Mitral regurgitation · Mitral annular · Annulus height · Real-time 3D transesophageal echocardiography.
Volume 25, No 2
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