title: Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty: a three-dimensional intraoperative transesophageal study.
abstract: BACKGROUND
  Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning.
  
  
  METHODS
  Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software.
  
  
  RESULTS
  MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm(2) in FED and 15.4 ± 3.8 cm(2) in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm(2)), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm(2) in FED, 4.9 ± 1.3 cm(2) in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery.
  
  
  CONCLUSIONS
  Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.
authors.affiliation: Department of Biomedical Engineering, Politecnico di Milano, Milan, Italy. francesco.maffessanti@mail.polimi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Maffessanti
authors.forename: Nina A
authors.initials: NA
authors.lastname: Marsan
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Enrico G
authors.initials: EG
authors.lastname: Caiani
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012984:Software; D018709:Statistics, Nonparametric