Quantitative Assessment Of Mitral Valve And Annulus Geometry In The Ischemic And Non-ischemic Mitral Regurgitation By Real-time Three-dimensional Transesophageal Echocardiography

Objective To quantitatively assess the remodeling of mitral valveand annulus geometry in the ischemic mitral regurgitation（IMR) andnon-ischemic mitral regurgitation（MR）by real-time three-dimensionaltransesophageal echocardiography （RT-3D-TEE），and provide a basis forsurgical cardiac surgery.Methods ninety-eight patients were enrolled to underwentRT-3D-TEE examination in this study. Patients were divided into threegroups: IMR group (n=43)、MR group (n=33), no mitral regurgitationgroup (control group, n=22). Full-volume3D dynamic images of mitralannulus and valve were obtained, The images were off-line analyzed usingQlab7.0MVQ workstation, and the geometry Indexes: area of leaflets(A3DE), area of anterior leaflet (A3DE Ant), area of posterior leaflet(A3DE Post), perimeter of annulus (C3D), anterolateral to posteromedialdiameter of annulus (DAlPm), anterior to posterior diameter of annulus (DAP), annulus height (H), maximal prolapse height (HProl), maximaltenting height (HTent), volume of leaflet prolapse (Vprol), volume of theleaflets tent (Vtent), Aortic orifice to mitral plane angle (θ), angle ofanterior leaflet (θAnt), non-planar angle of leaflets (θNPA), angle ofposterior leaflet (θPost) and other mitral valve leaflets and annulus, werederived and statistically analyzed.Results Compared with the control group, significant increases ofA3DE, A3DE Ant, DAP and θPost, and decreases of θ and θNPA weredemonstrated in IMR group, the differences were statistically significant (P<0.05); Significant increases of A3DE, A3DE Ant, DAP, HProl, Vprol andθNPA, and decreases of θ、θAnt and θPost were explored in MR group, thedifferences were statistically significant (P <0.05); compared with MRgroup, a reduction of A3DE, A3DE Ant, DAP、HProl and θNPA, andincreases of θAnt and θPost were found in IMR group and the differenceswere statistically significant (P <0.05).Conclusions All the causes of mitral regurgitation could lead tomitral annulus dilatation, leaflets area increase, and mitral annulusgeometry change, the overall mitral annulus tends to flatten were moreobvious in the non-ischemic MR group than those in IMR group. Theprolapse is more prominent in MR group than those in IMR Group. Thedifference of mitral annulus geometry between IMR group and MR groupindicates that the damage of the mitral leaflets and annulus might be more serious in MR group.