title: Three-dimensional echocardiographic assessment of changes in mitral valve geometry after valve repair.
abstract: BACKGROUND
  Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair.
  
  
  METHODS
  We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared.
  
  
  RESULTS
  Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 +/- 14 versus 146 +/- 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings.
  
  
  CONCLUSIONS
  Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity.
authors.affiliation: Department of Anesthesia and Critical Care and Pain Management, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. fmahmood@bidmc.harvard.edu
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Balachundhar
authors.initials: B
authors.lastname: Subramaniam
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levine
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Andrew
authors.initials: A
authors.lastname: Maslow
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Panzica
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hagberg
authors.forename: Swaminathan
authors.initials: S
authors.lastname: Karthik
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D011184:Postoperative Period; D015203:Reproducibility of Results