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J Thorac Cardiovasc Surg 2008;136:726-734
© 2008 The American Association for Thoracic Surgery

Evolving Technology

A methodology for assessing human mitral leaflet curvature using real-time 3-dimensional echocardiography

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

Received for publication October 25, 2007; revisions received December 20, 2007; accepted for publication February 3, 2008.

^_* Address for reprints: Joseph H. Gorman, III, MD, Department of Surgery, University of Pennsylvania, Glenolden Research Laboratory, 500 S Ridgeway Ave, 2nd Floor, Room 249, Glenolden, PA 19036. (Email: gormanj{at}uphs.upenn.edu).

Objectives: Using 3-dimensional echocardiography in conjunction with novel geometric modeling and rendering techniques, we have developed a high-resolution, quantitative, 3-dimensional methodology for imaging the human mitral valve. Leaflet and annular geometry are important determinants of mitral valve stress. Repair techniques that optimize valvular geometry will reduce stress and potentially increase repair durability. The development of such procedures will require image-processing methodologies that provide a quantitative description of 3-dimensional valvular geometry.

Methods: Ten healthy adult subjects underwent mitral valve imaging with real-time 3-dimensional echocardiography. By using specially designed image analysis software, multiple valvular geometric parameters, including 2- and 3-dimensional leaflet curvature, leaflet surface area, annular height, intercommissural width, septolateral annular diameter, and annular area were determined for each subject. Image-rendering techniques that allow for the clear and concise presentation of this detailed information are also presented.

Results: Although 3-dimensional annular and leaflet geometry were found to be highly conserved between healthy human subjects in general, substantial intrasubject and intersubject regional geometric heterogeneity was observed in the midposterior leaflet, the region most commonly involved in leaflet flail in subjects with myxomatous disease.

Conclusions: The image-processing and graphic-rendering techniques that we have developed can be used to provide a complete description of 3-dimensional mitral valve geometry in human subjects. Widespread application of these techniques to healthy subjects and patients with mitral valve disease will provide insight into the geometric basis of both valvular pathology and repair durability.