Karsten Bartels1, Robert H Thiele2, Barbara Phillips-Bute1, Donald D Glower3, Madhav Swaminathan1, Joseph Kisslo4, G Burkhard Mackensen5. 1. Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC. 2. Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA. 3. Department of Surgery, Division of Cardiovascular and Thoracic Surgery. 4. Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC. 5. Department of Anesthesiology and Pain Medicine, Division of Cardiothoracic Anesthesiology, University of Washington, Seattle, WA. Electronic address: gbmac@uw.edu.
Abstract
OBJECTIVE: Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves. DESIGN: Case-control observational clinical study. SETTING: Tertiary care hospital. PARTICIPANTS: Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease. MEASUREMENTS AND MAIN RESULTS: Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices. CONCLUSIONS: Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.
OBJECTIVE: Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves. DESIGN: Case-control observational clinical study. SETTING: Tertiary care hospital. PARTICIPANTS: Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease. MEASUREMENTS AND MAIN RESULTS: Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices. CONCLUSIONS: Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.
Authors: Matthew A Jolley; Peter E Hammer; Sunil J Ghelani; Adi Adar; Lynn A Sleeper; Ronald V Lacro; Gerald R Marx; Meena Nathan; David M Harrild Journal: J Am Soc Echocardiogr Date: 2018-08-08 Impact factor: 5.251
Authors: Alex V Nguyen; Andras Lasso; Hannah H Nam; Jennifer Faerber; Ahmed H Aly; Alison M Pouch; Adam B Scanlan; Francis X McGowan; Laura Mercer-Rosa; Meryl S Cohen; John Simpson; Gabor Fichtinger; Matthew A Jolley Journal: J Am Soc Echocardiogr Date: 2019-02-28 Impact factor: 5.251
Authors: Hannah H Nam; Patrick V Dinh; Andras Lasso; Christian Herz; Jing Huang; Adriana Posada; Ahmed H Aly; Alison M Pouch; Saleha Kabir; John Simpson; Andrew C Glatz; David M Harrild; Gerald Marx; Gabor Fichtinger; Meryl S Cohen; Matthew A Jolley Journal: Ann Thorac Surg Date: 2020-12-24 Impact factor: 4.330