title: Mitral valve dynamics in severe aortic stenosis before and after aortic valve replacement.
abstract: BACKGROUND
  The aortic and mitral valves are anatomically linked through a fibrous continuity. The investigators hypothesized that severe aortic stenosis (AS) would alter this fibrous continuity, affecting both the mitral valve and left ventricular function, and that mitral valve function would be altered after aortic valve replacement (AVR). The aim of this study was to evaluate the impact of AS and its treatment with surgical AVR on the mitral valve.
  
  
  METHODS
  Three-dimensional transesophageal echocardiography (using a Philips iE33 system) was performed on 49 patients: 20 controls with normal valves and left ventricular function, 20 with AS and normal left ventricular function studied before and after AVR, and nine with systolic heart failure and normal valves. Custom software tracked the aortic and mitral valves in three-dimensional space, allowing automated measurements of aortic and mitral annular (MA) morphology throughout the cardiac cycle.
  
  
  RESULTS
  Patients with AS before AVR had reduced MA velocities. After AVR, aortic and MA areas were significantly smaller throughout the cardiac cycle compared with controls and pre-AVR values. MA displacement was reduced after AVR and in patients with systolic heart failure compared with those with AS and controls.
  
  
  CONCLUSIONS
  Dynamic MA function is changed with AS and after AVR through alterations in the aortic-mitral fibrous continuity. The prosthetic valve ring results in reduced aortic and MA areas, which could affect blood flow in and out of the left ventricle. These changes suggest that the design of future prosthetic aortic valves should be more flexible to preserve the function of the aortic-mitral fibrous continuity.
authors.affiliation: University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Tsang
authors.forename: Federico
authors.initials: F
authors.lastname: Veronesi
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Lynn
authors.initials: L
authors.lastname: Weinert
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery*; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012984:Software