title: Mitral annulus distortion during beating heart surgery: a potential cause for hemodynamic disturbance--a three-dimensional echocardiography reconstruction study.
abstract: BACKGROUND
  Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described.
  
  
  METHODS
  With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium.
  
  
  RESULTS
  Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures.
  
  
  CONCLUSIONS
  Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.
authors.affiliation: Department of Anaesthesia, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, United Kingdom. s.george@rbh.nthames.nhs.uk
authors.forename: Shane J
authors.initials: SJ
authors.lastname: George
authors.forename: Sharif
authors.initials: S
authors.lastname: Al-Ruzzeh
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003971:Diastole / Q000502:physiology; D019560:Echocardiography, Three-Dimensional; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D012307:Risk Factors; D013599:Systole / Q000502:physiology