HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert C. Gorman Joseph H. Gorman, III Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ryan, L. P. Articles by Gorman, J. H. Search for Related Content PubMed Articles by Ryan, L. P. Articles by Gorman, J. H., III Related Collections Valve disease

J Thorac Cardiovasc Surg 2007;134:644-648
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Description of regional mitral annular nonplanarity in healthy human subjects: A novel methodology

^a Harrison Department of Surgical Research, Philadelphia, Pa
^b Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa.

Received for publication November 30, 2006; revisions received January 31, 2007; accepted for publication February 23, 2007.

^_* Address for reprints: Joseph H. Gorman III, MD, University of Pennsylvania School of Medicine, 313 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, PA 19104-4283. (Email: gormanj{at}uphs.upenn.edu).

Objective: Finite-element analysis demonstrates that the nonplanar shape of the mitral annulus diminishes mitral leaflet stress. It has therefore been postulated that repair with annuloplasty rings that maintain the nonplanar shape of the annulus could increase repair durability. Although the global nonplanarity of the mitral annulus has been adequately characterized, design of such a ring requires a quantitative description of regional annular geometry. By using real-time 3-dimensional echocardiography in conjunction with available image processing software, we developed a methodology for describing regional annular geometry and applied it to the characterization of the normal human mitral annulus.

Methods: Five healthy volunteers underwent mitral valve imaging with real-time 3-dimensional echocardiography. Regional annular height was calculated at 36 evenly spaced intervals.

Results: Maximal annular height/commissural width ratio was found to occur at the midpoint of the anterior annulus in all cases. These values averaged 26% ± 3.1%, whereas those for the midposterior annulus averaged 18% ± 3.0%. The average commissural width was 35.2 ± 6.0 mm. Although substantial spatial heterogeneity was observed, regional annular height at a given rotational position was highly conserved among subjects when normalized to commissural width.

Conclusions: These quantitative imaging and analytic techniques demonstrate that the normal human mitral annulus is regionally heterogeneous in its nonplanarity, and they establish a means of describing annular geometry at a regional level. With wider application, these techniques may be used both to characterize pathologic annular geometry and to optimize the design of mitral valve annuloplasty devices.

This article has been cited by other articles:

				L. P. Ryan, B. M. Jackson, H. Hamamoto, T. J. Eperjesi, T. J. Plappert, M. St. John-Sutton, R. C. Gorman, and J. H. Gorman III The Influence of Annuloplasty Ring Geometry on Mitral Leaflet Curvature Ann. Thorac. Surg., September 1, 2008; 86(3): 749 - 760. [Abstract] [Full Text] [PDF]