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Mitral annular hinge motion contribution to changes in mitral septal–lateral dimension and annular area  Akinobu Itoh, MD, Daniel B. Ennis, PhD, Wolfgang.

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Presentation on theme: "Mitral annular hinge motion contribution to changes in mitral septal–lateral dimension and annular area  Akinobu Itoh, MD, Daniel B. Ennis, PhD, Wolfgang."— Presentation transcript:

1 Mitral annular hinge motion contribution to changes in mitral septal–lateral dimension and annular area  Akinobu Itoh, MD, Daniel B. Ennis, PhD, Wolfgang Bothe, MD, Julia C. Swanson, MD, Gaurav Krishnamurthy, MS, Tom C. Nguyen, MD, Neil B. Ingels, PhD, D. Craig Miller, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 138, Issue 5, Pages (November 2009) DOI: /j.jtcvs Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 A, Schematic representation of marker array in left ventricle (LV), mitral annulus, and leaflets. Best-fit plane is applied to fibrous annulus and muscular annulus. Angle from muscular plane to fibrous plane was defined as hinge angle (Ф). B, Mitral annular and leaflet markers, annular dimensions. EA, anterior mitral leaflet midedge; EP, posterior mitral leaflet midedge; H-S, hinge–saddle-horn dimension; H-L, hinge–lateral (muscular) dimension; S-L, septal–lateral dimension. C, Schematic representations of 3-dimensional total mitral annular area (a) and 3-dimensional muscular and fibrous areas (b), with 2-dimensional projections on least squares–fit plane. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Hinge-angle change (ΔФ) in cardiac cycle. Changes in mitral hinge angle during 3 consecutive heart beats of all animals (n = 17, raw data) normalized in percentage of cardiac cycles with mean left ventricular and aortic pressure curves. IVC, Isovolumic contraction; IVR, isovolumic relaxation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Mitral valve dynamics. Hinge angle, annular height (A-H), leaflet edge marker distance (EA-EP), 3-dimensional total mitral annular area (MAA, 3D-TA), septal-lateral dimension (S-L), with aortic pressure (AoP), left ventricular pressure (LVP), and left ventricular (LV) volume (LVV) throughout 3 cardiac cycles in representative heart. Note that hinge angle and annular height changes are quite similar, and most other parameters also change during isovolumic contraction or relaxation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Mitral annular profiles in 3 orthographic drawings: A, Aortic view, as viewed from septum to lateral wall (S-L); B, atrial view, as viewed from left atrium to left ventricle (A-H); C, commissure view, as viewed from anterior to posterior commissure (C-C). Data are group mean (n = 17) at end diastole (ED, red), end systole (ES, blue), and E wave (green). Marker indicates saddle-horn. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Schematic representation of septal–lateral reduction during isovolumic contraction with mean data of change in hinge angle (ΔФ), hinge axis–midlateral dimension, and hinge axis–saddle-horn dimension. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Schematic representations of 3-dimensional (3D) and 2-dimensional (2D) mitral annular area changes at end diastole (ED) and end systole (ES). Note that 2-dimensional fibrous annular area reduces as change in hinge angle increases. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

8 Figure 7 Schematic representations of speculative mitral annular dynamics with fixed hinge motion (A), fixed muscular annulus with partial annuloplasty ring (B), and rigid complete ring (C), derived from actual mean data of change in hinge angle (ΔФ), hinge axis–saddle horn dimension, and hinge axis–midlateral dimension. Note that contributions by hinge motion and hinge axis–midlateral dimension are almost equal to septal–lateral (S-L) dimension change. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

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