title: Changes in mitral annular geometry after aortic valve replacement: a three-dimensional transesophageal echocardiographic study.
abstract: OBJECTIVE
  Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR).
  
  
  METHODS
  A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters.
  
  
  RESULTS
  Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p < 0.001), circumference (-8.9%, p < 0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p < 0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 6.2%, p < 0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter.
  
  
  CONCLUSIONS
  The mitral annulus undergoes significant geometric changes immediately after AVR. Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve.
authors: Department of Anesthesia, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
authors: Feroze
authors: F
authors: Mahmood
authors: Haider J
authors: HJ
authors: Warraich
authors: Joseph H
authors: JH
authors: Gorman
authors: Robert C
authors: RC
authors: Gorman
authors: Tzong-Huei
authors: TH
authors: Chen
authors: Peter
authors: P
authors: Panzica
authors: Andrew
authors: A
authors: Maslow
authors: Kamal
authors: K
authors: Khabbaz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D017558:Elective Surgical Procedures; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D016896:Treatment Outcome