title: Regional changes in coaptation geometry after reduction annuloplasty for functional mitral regurgitation.
abstract: BACKGROUND
  While it is known that band annuloplasty for functional mitral regurgitation (FMR) improves leaflet coaptation, the effect on regional coaptation geometry has not previously been well defined. We used three-dimensional transesophageal echocardiography (3D-TEE) to analyze the regional effects of semirigid band annuloplasty on annular geometry and leaflet coaptation zones of patients with FMR.
  
  
  METHODS
  Sixteen patients with severe FMR underwent a semirigid band annuloplasty. Intraoperative full volume 3D-TEE datasets were acquired pre valve and post valve repair. Offline analysis assessed annular dimensions and regional coaptation zone geometry. The regions were defined as R1 (A1-P1), R2 (A2-P2), and R3 (A3-P3); coaptation distance, coaptation depth, and coaptation length were measured in each region. Differences were analyzed with repeated measures within a general linear model.
  
  
  RESULTS
  Band annuloplasty decreased mitral regurgitation grade from 3.7 to 0.1 (scale 0 to 4). Annular septolateral dimension (p<0.01) and coaptation distance (p<0.01) decreased significantly in all regions. Likewise, anterior and posterior leaflet coaptation lengths increased in all regions (p<0.01 and p=0.05, respectively), with region 2 showing the greatest increase (p=0.01). Changes in coaptation depth were not significant.
  
  
  CONCLUSIONS
  Semirigid band annuloplasty for FMR produces significant regional remodeling of leaflet coaptation zones, with region 2 showing the greatest increase in leaflet coaptation length. This regional analysis of annular geometry and leaflet coaptation creates a framework to better understand the mechanisms of surgical success or failure of annuloplasty for FMR.
authors.affiliation: Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York 10016, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Greenhouse
authors.forename: Sophia L
authors.initials: SL
authors.lastname: Dellis
authors.forename: Charles F
authors.initials: CF
authors.lastname: Schwartz
authors.forename: Didier F
authors.initials: DF
authors.lastname: Loulmet
authors.forename: David W
authors.initials: DW
authors.lastname: Yaffee
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*