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Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse?  Rakesh M. Suri, MD, DPhil, Jasmine Grewal,

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Presentation on theme: "Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse?  Rakesh M. Suri, MD, DPhil, Jasmine Grewal,"— Presentation transcript:

1 Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse?  Rakesh M. Suri, MD, DPhil, Jasmine Grewal, MD, Sunil Mankad, MD, Maurice Enriquez-Sarano, MD, Fletcher A. Miller, MD, Hartzell V. Schaff, MD  The Annals of Thoracic Surgery  Volume 88, Issue 4, Pages (October 2009) DOI: /j.athoracsur Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

2 Figure 1 Three-dimensional (3D) echocardiographic images. (A) Preoperative 3D echocardiogram images of a flail middle scallop of the posterior leaflet. Trigones are demarcated (star). (B) Postoperative 3D echocardiogram images after mitral valve repair with the annuloplasty band anchored at the fibrous trigones (star). (C) Atrial view of the mitral annulus at end diastole without (left panel) and with (right panel) measurement markers. Verification of correct position of measurement markers on the mitral annulus was obtained in three orthogonal planes. (A = anterior; AL = anterolateral; P = posterior; PM = posteromedial.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Measurement of the intertrigonal distance. The bar graph presents anterior intertrigonal distance measurements by the surgeon versus two repeat three-dimensional (3D) echocardiographic calculations. There was no significant difference in the distance obtained between the two techniques (p = 0.73) or between repeat echocardiogram measurements (p = 0.41). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Measurement of the mitral annulus. The bar graph presents mitral annular measurements by three-dimensional echocardiography averaged over the cardiac cycle comparing normal controls () versus myxomatous leaflet prolapse cases prior to mitral valve repair (□). The total circumference and posterior mitral annulus length are both significantly increased in leaflet prolapse cases (*: p < 0.001) while the intertrigonal distance is similar to normal controls (p = 0.13). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Mitral annular dynamics before and after mitral valve repair. The line plots present total mitral annular circumference of leaflet prolapse cases measured by three-dimensional echocardiography before (- - -) and after (—) mitral valve repair including a standard length flexible 63 mm posterior annuloplasty band. The total circumference is significantly smaller postrepair at all time points during the cardiac cycle (*, p < 0.001). Significant cyclic enlargement of the mitral annulus is noted between early diastole and late systole prerepair (⋆, p = 0.001) which is preserved after valve repair (+, p = 0.004). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

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