Acute Effect Of Mitral Valve Repair On Mitral Valve Geometry
Thilo Noack, Kathleen Wittgen, Philipp Kiefer, Fabian Emrich, Sarah Eibel, David Michael Holzhey, Martin Misfeld, Friedrich-Wilhelm Mohr, Michael Andrew Borger, Joerg Ender, Joerg Seeburger.
Heart Center Leipzig, Leipzig, Germany.
Background - The aim of this study was to quantify the acute dynamic changes of mitral valve (MV) geometry throughout the cardiac cycle - during surgical mitral valve repair (MVR) with ring annuloplasty and optional neochord implantation by 3-dimensional transesophageal echocardiography (3D TEE). Methods - Twenty-nine patients (age 63±10 years) with severe primary MR underwent surgical MVR for primary MR using ring anuloplasty with or without neochord implantation. Mitral valve was recorded throughout the cardiac cycle (CC) before and after MVR using 3D TEE. Dynamic changes in the MV annulus geometry and anatomical MV orifice area were quantified using a novel automated software (eSie Valves, Siemens Healthcare, USA).Results - MVR significantly reduces the anterior-posterior diameter up to 38% (AP-diameter at 30% of CC; from 36.8 mm to 22.7 mm; P<0.001) and lateral-medial diameter up to 31% (LM-diameter at 30% of CC; from 42.7 mm to 30.3 mm; P<0.001) throughout CC. Annular circumference was reduced up to 31% (at 30% of CC; from 129.6 mm to 87.6 mm, P<0.001), and annular area was significantly decreased up to 52% (at 30% of CC; from 12.8 cm2 to 5.7 cm2; P<0.001) throughout CC. Anatomical regurgitation orifice area (AROA) was decreased in maximum from 1.1 cm2 to 0.2 cm2 (at 20% of CC; P<0.001), and anatomical MV orifice area was also decreased in maximum from 4.1 cm2 to 3.2 cm2 (P<0.001). Conclusions - The present study is the first to characterize acute geometrical effects of MVR for primary MR by 4D valve analysis. Successful MVR could be observed by reduction of annular parameters and AROA. Mitral valve repair induced changes in MV geometry however reach an unexpected extent not yet described in detail. 
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