title: Maintenance of geometric alterations associated with percutaneous mitral valve repair: real-time three-dimensional echocardiographic assessment in an ovine model.
abstract: OBJECTIVE
  Percutaneous catheter-based mitral annuloplasty (PTMA) exploits the anatomic proximity of the coronary sinus (CS) to the mitral valve apparatus. Acute results of PTMA have been favorable, but the durability of the geometric alterations associated with PTMA has not been reported. The study aim was to assess the three-dimensional (3D) geometry of the mitral annulus (MA) in normal sheep at 20 weeks after PTMA implantation.
  
  
  METHODS
  A PTMA device was implanted percutaneously in the CS of 10 normal sheep without mitral regurgitation. All animals were followed for 20 weeks with real-time 3D echocardiography (RT3DE). The MA area, the diagonal diameters in four directions, and the angle alpha, representing the degree of the saddle shape of MA, were determined.
  
  
  RESULTS
  No significant hemodynamic, pathologic or mechanical complications were observed during implantation or follow up. Both, the MA area (from 4.8 +/- 0.9 cm2 to 3.7 +/- 0.9 cm2) and anterior-posterior (A-P) diameter (from 21.4 +/- 3.0 mm to 17.6 +/- 2.4 mm) were reduced immediately after the procedure (both p <0.05). The angle alpha decreased after the procedure (from 142.0 +/- 11.5 degrees to 128.3 +/- 15.6 degrees; p <0.05). These changes remained stable over the 20-week follow up period.
  
  
  CONCLUSIONS
  RT3DE demonstrates that PTMA reduces the MA area and A-P diameter and maintains the physiologic curved or saddle shape of the MA. These changes remained stable for 20 weeks after device implantation.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: John R
authors.initials: JR
authors.lastname: Liddicoat
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saracino
authors.forename: Motoya
authors.initials: M
authors.lastname: Hayase
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Schneider
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization; D013504:Cardiovascular Surgical Procedures / Q000295:instrumentation / Q000379:methods; D003198:Computer Simulation; D019560:Echocardiography, Three-Dimensional; D006350:Heart Valve Prosthesis; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D023421:Models, Animal; D008955:Models, Cardiovascular; D012756:Sheep