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): Tom C. Nguyen Akinobu Itoh Wolfgang Bothe Tomasz A. Timek Robert A. Oakes Neil B. Ingels, Jr. D. Craig Miller Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nguyen, T. C. Articles by Miller, D. C. Search for Related Content PubMed Articles by Nguyen, T. C. Articles by Miller, D. C. Related Collections Cardiac - physiology Congestive Heart Failure Peripheral vascular Valve disease

J Thorac Cardiovasc Surg 2008;136:557-565
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

The effect of pure mitral regurgitation on mitral annular geometry and three-dimensional saddle shape

^a Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
^b Department of Clinical Physiology, University Hospital, Linköping, Sweden
^c Division of Cardiovascular Medicine, Stanford, California
^d Research Institute, Palo Alto Medical Foundation, Palo Alto, California

Received for publication May 23, 2007; revisions received November 26, 2007; accepted for publication December 18, 2007.

^_* Address for reprints: D. Craig Miller, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247. (Email: dcm{at}stanford.edu).

Objective: Chronic ischemic mitral regurgitation is associated with mitral annular dilatation in the septal-lateral dimension and flattening of the annular 3-dimensional saddle shape. To examine whether these perturbations are caused by the ischemic insult, mitral regurgitation, or both, we investigated the effects of pure mitral regurgitation (low pressure volume overload) on annular geometry and shape.

Methods: Eight radiopaque markers were sutured evenly around the mitral annulus in sheep randomized to control (CTRL, n = 8) or experimental (HOLE, n = 12) groups. In HOLE, a 3.5- to 4.8-mm hole was punched in the posterior leaflet to generate pure mitral regurgitation. Four-dimensional marker coordinates were obtained radiographically 1 and 12 weeks postoperatively. Mitral annular area, annular septal-lateral and commissure–commissure dimensions, and annular height were calculated every 16.7 ms.

Results: Mitral regurgitation grade was 0.4 ± 0.4 in CTRL and 3.0 ± 0.8 in HOLE (P < .001) at 12 weeks. End-diastolic left ventricular volume index was greater in HOLE at both 1 and 12 weeks; end-systolic volume index was larger in HOLE at 12 weeks. Mitral annular area increased in HOLE predominantly in the commissure–commissure dimension, with no difference in annular height between HOLE versus CTRL at 1 or 12 weeks, respectively.

Conclusion: In contrast with annular septal-lateral dilatation and flattening of the annular saddle shape observed with chronic ischemic mitral regurgitation, pure mitral regurgitation was associated with commissure–commissure dimension annular dilatation and no change in annular shape. Thus, infarction is a more important determinant of septal-lateral dilatation and annular shape than mitral regurgitation, which reinforces the need for disease-specific designs of annuloplasty rings.

This article has been cited by other articles:

				R. M. Suri, J. Grewal, S. Mankad, M. Enriquez-Sarano, F. A. Miller Jr, and H. V. Schaff Is the anterior intertrigonal distance increased in patients with mitral regurgitation due to leaflet prolapse? Ann. Thorac. Surg., October 1, 2009; 88(4): 1202 - 1208. [Abstract] [Full Text] [PDF]