title: Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet.
abstract: BACKGROUND
  The primary goal of surgical mitral repair is the reestablishment of normal leaflet coaptation. Surgical techniques that maintain or restore leaflet geometry promote leaflet coaptation. Recent 3-dimensional (3D) echocardiographic studies have shown that saddle-shaped annuloplasty has a salutary influence on leaflet geometry. Therefore we hypothesized that saddle-shaped annuloplasty would improve leaflet coaptation in cases of repair for flail posterior leaflet segments.
  
  
  METHODS
  Sixteen patients with flail posterior segment and severe mitral regurgitation had valve repair using standard techniques. Eight patients received saddle-shaped annuloplasty and 8 patients received flat annuloplasty. Real-time 3D transesophageal echocardiography was performed before and after repair. Images were analyzed using custom software to calculate mitral annular area (MAA), septolateral dimension (SLD), intercommissural width (CW), total leaflet area (TLA), and leaflet coaptation area (LCA).
  
  
  RESULTS
  Postrepair MAA (flat, 588.6±26.5 mm2; saddle, 628.0±35.3 mm2; p=0.12) and TLA (flat, 2198.5±151.6 mm2; saddle, 2303.9±183.8 mm2; p=0.67) were similar in both groups. Postrepair LCA was significantly greater in the saddle group than in the flat group (226.8±24.0 mm2 and 154.0±13.0 mm2, respectively; p=0.02).
  
  
  CONCLUSIONS
  Real-time 3D echocardiography and novel imaging software provide a powerful tool for analyzing mitral leaflet coaptation. When compared with flat annuloplasty, saddle-shaped annuloplasty improves LCA after mitral valve repair for severe mitral regurgitation secondary to flail posterior leaflet segment. Use of saddle-shaped annuloplasty devices may increase repair durability.
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Weiss
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Gillespie
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
mesh_terms: D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011184:Postoperative Period; D011474:Prosthesis Design