title: Geometric deformity of the mitral annulus in patients with ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study.
abstract: OBJECTIVE
  Saddle-shaped non-planarity of the mitral annulus has been investigated previously. The study aim was to further clarify the configuration of the mitral annulus in ischemic mitral regurgitation (MR) by using transthoracic real-time three-dimensional (3-D) echocardiography.
  
  
  METHODS
  Twenty-five patients with previous myocardial infarction and left ventricular dysfunction (ejection fraction < 50%), and 10 healthy control subjects, were examined using real-time 3-D transthoracic echocardiography. The patients were allocated to either a non-MR group or an MR group. By using real-time 3-D echocardiography, the configuration of the mitral annulus was reconstructed in end-systole, and the height of the saddle-shaped mitral annulus calibrated (non-planar index).
  
  
  RESULTS
  In controls, the mitral annulus appeared as non-planar 'saddle shape', with a non-planar index of 5.5 +/- 1.7 mm. The mitral annulus was flattened in both the non-MR and MR groups. The non-planar index was significantly smaller in the MR group than in the non-MR group (1.7 +/- 1.8 mm versus 3.8 +/- 1.2 mm, p < 0.05). The systolic annular area was significantly larger in the MR group than the non-MR group.
  
  
  CONCLUSIONS
  The 'saddle shape' of the mitral annulus was deformed in patients with ischemic MR. Mitral annulus deformation may play a role in ischemic MR in conjunction with mitral valve tenting. These results suggest that a non-planar saddle-shaped annuloplasty ring would contribute to successful mitral valve repair durability in patients with ischemic MR.
authors.affiliation: Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. non@med.kawasaki-m.ac.jp
authors.forename: Nozomi
authors.initials: N
authors.lastname: Watanabe
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Yamaura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kawamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D009203:Myocardial Infarction / Q000150:complications; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications