title: Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography.
abstract: OBJECTIVE
  Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient's functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform annuloplasty ring using three-dimensional (3D) echocardiography.
  
  
  RESULTS
  Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4+/-0.2 to 0.9+/-0.3 (P-value<0.0001), mitral valve tenting volume from 13+/-1.7 to 3.2+/-0.3 mL (P-value<0.001), annulus area from 12.6+/-1.0 to 3.3+/-0.2 cm2 (P-value<0.0001), valve circumference from 13+/-0.5 to 7.3+/-0.3 cm (P-value<0.0001), septolateral distance from 2.1+/-0.1 to 1.4+/-0.06 cm (P-value<0.01) and intercommissural distance from 3.4+/-0.1 to 2.7+/-0.03 cm (P-value<0.03). There was significant decrease in the septolateral distance at the level of A2-P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1+/-0.3 to 1.3+/-0.3 (P-value<0.002).
  
  
  CONCLUSIONS
  The mitral valve annuloplasty with the Geoform ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry.
authors.affiliation: Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Armen
authors.forename: Rashmi
authors.initials: R
authors.lastname: Vandse
authors.forename: Juan A
authors.initials: JA
authors.lastname: Crestanello
authors.forename: Subha V
authors.initials: SV
authors.lastname: Raman
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Bickle
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Nathan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome