title: Dynamism of the mitral annulus: a spatial and temporal analysis.
abstract: OBJECTIVE
  In this study, the authors sought to investigate the extent and timing of changes in mitral annular area during the cardiac cycle. Particularly, the authors assessed whether these changes were limited to the posterior part of the annulus or were more global in nature.
  
  
  METHODS
  Prospective, observational study
  
  
  METHODS
  Tertiary care university hospital
  
  
  METHODS
  Twenty three patients undergoing non-valvular cardiac surgery and 3 patients undergoing vascular procedures.
  
  
  METHODS
  Intraoperative 3-dimensional transesophageal echocardiographic data obtained from patients with normal mitral valves undergoing non-valvular cardiac surgery were analyzed geometrically. Annular areas and diameters were measured during various stages of the cardiac cycle. Intertrigonal distance also was measured using 3D data.
  
  
  RESULTS
  Both anterior and posterior portions of the mitral annulus demonstrated dynamism throughout the cardiac cycle. The expansion phase ranged from mid-systole to early-diastole, whereas mid-diastole to early-systole was characterized by an annular contraction phase. Area changes were contributed equally by anterior and posterior parts of the annulus. Annular dimensions increased in accordance with mitral annular area (p<0.05). Echocardiographically-identified intertrigonal distance showed the least delta change.
  
  
  CONCLUSIONS
  Both the anterior and posterior parts of the annulus contribute to changes in mitral annular area, which undergoes discrete expansion and contraction phases that extend into both systole and diastole. Compared to other annular dimensions, the echocardiographically-identified intertrigonal distance does not change significantly during the cardiac cycle.
authors.affiliation: Department of Anesthesia and Pain Medicine Peking University People's Hospital, Beijing, China; Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Luyang
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Owais
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.affiliation: Division of Cardiac Surgery Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
authors.affiliation: Division of Cardiac Surgery Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Liu
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Departamento de Anestesiología, Hospital México, C.C.S.S., Universidad de Costa Rica, San José, Costa Rica.
authors.forename: Mario
authors.initials: M
authors.lastname: Montealegre-Gallegos
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Hess
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: fmahmood@bidmc.harvard.edu.
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000502:physiology*; D011446:Prospective Studies; D013997:Time Factors
keywords: cardiac surgery; mitral valve; mitral valve annulus; transesophageal echocardiography