Luyang Jiang1, Khurram Owais2, Robina Matyal2, Kamal R Khabbaz3, David C Liu3, Mario Montealegre-Gallegos4, Philip E Hess2, Feroze Mahmood5. 1. Department of Anesthesia and Pain Medicine Peking University People's Hospital, Beijing, China; Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 2. Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 3. Division of Cardiac Surgery Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 4. Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Departamento de Anestesiología, Hospital México, C.C.S.S., Universidad de Costa Rica, San José, Costa Rica. 5. Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: fmahmood@bidmc.harvard.edu.
Abstract
OBJECTIVE: In this study, the authors sought to investigate the extent and timing of changes in mitral annular area during the cardiac cycle. Particularly, the authors assessed whether these changes were limited to the posterior part of the annulus or were more global in nature. DESIGN: Prospective, observational study SETTING: Tertiary care university hospital PARTICIPANTS: Twenty three patients undergoing non-valvular cardiac surgery and 3 patients undergoing vascular procedures. INTERVENTIONS: Intraoperative 3-dimensional transesophageal echocardiographic data obtained from patients with normal mitral valves undergoing non-valvular cardiac surgery were analyzed geometrically. Annular areas and diameters were measured during various stages of the cardiac cycle. Intertrigonal distance also was measured using 3D data. MEASUREMENTS AND MAIN RESULTS: Both anterior and posterior portions of the mitral annulus demonstrated dynamism throughout the cardiac cycle. The expansion phase ranged from mid-systole to early-diastole, whereas mid-diastole to early-systole was characterized by an annular contraction phase. Area changes were contributed equally by anterior and posterior parts of the annulus. Annular dimensions increased in accordance with mitral annular area (p<0.05). Echocardiographically-identified intertrigonal distance showed the least delta change. CONCLUSIONS: Both the anterior and posterior parts of the annulus contribute to changes in mitral annular area, which undergoes discrete expansion and contraction phases that extend into both systole and diastole. Compared to other annular dimensions, the echocardiographically-identified intertrigonal distance does not change significantly during the cardiac cycle.
OBJECTIVE: In this study, the authors sought to investigate the extent and timing of changes in mitral annular area during the cardiac cycle. Particularly, the authors assessed whether these changes were limited to the posterior part of the annulus or were more global in nature. DESIGN: Prospective, observational study SETTING: Tertiary care university hospital PARTICIPANTS: Twenty three patients undergoing non-valvular cardiac surgery and 3 patients undergoing vascular procedures. INTERVENTIONS: Intraoperative 3-dimensional transesophageal echocardiographic data obtained from patients with normal mitral valves undergoing non-valvular cardiac surgery were analyzed geometrically. Annular areas and diameters were measured during various stages of the cardiac cycle. Intertrigonal distance also was measured using 3D data. MEASUREMENTS AND MAIN RESULTS: Both anterior and posterior portions of the mitral annulus demonstrated dynamism throughout the cardiac cycle. The expansion phase ranged from mid-systole to early-diastole, whereas mid-diastole to early-systole was characterized by an annular contraction phase. Area changes were contributed equally by anterior and posterior parts of the annulus. Annular dimensions increased in accordance with mitral annular area (p<0.05). Echocardiographically-identified intertrigonal distance showed the least delta change. CONCLUSIONS: Both the anterior and posterior parts of the annulus contribute to changes in mitral annular area, which undergoes discrete expansion and contraction phases that extend into both systole and diastole. Compared to other annular dimensions, the echocardiographically-identified intertrigonal distance does not change significantly during the cardiac cycle.