Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types.
OBJECTIVE
This study investigated computed tomographic (CT) appearance after mitral ring annuloplasty, especially comparing CT findings between patients with normal pressure gradient (PG) and patients with functional mitral stenosis (MS) and between 2 commonly used types of annuloplasty ring.


METHODS
A total of 45 cardiac CT scans in patients who underwent mitral ring annuloplasty (Carpentier-Edwards ring, n = 27; Duran ring, n = 18) were retrospectively reviewed. On CT scan, presence of significant pannus around the annuloplasty ring, presence of leaflet thickening, and maximal mitral opening area were analyzed. CT findings were compared between patients with normal PG and patients with functional MS (mean diastolic PG ≥ 5 mm Hg). Incidences of functional MS and CT findings were compared between ring types.


RESULTS
Significant pannus was present in 10 cases and leaflet thickening in 31 cases, and maximal opening area was 2.34 ± 0.717 cm(2). Valve opening area on CT was positively correlated with mitral valve area on transthoracic echocardiography and negatively correlated with mean diastolic PG. Mean diastolic PG was significantly elevated with increasing pannus severity. Patients with functional MS had more significant pannus than patients with normal PG. The Duran ring group had higher mean diastolic PG, smaller mitral valve area, and higher incidence of functional MS than the Carpentier-Edwards ring group (P < .05). The proportion of pannus and significant pannus was significantly higher in the Duran ring group (P < .05).


CONCLUSIONS
Significant pannus around the annuloplasty ring on CT may cause functional MS after mitral ring annuloplasty. This may occur more frequently with the Duran ring.
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Young Joo
YJ
Suh
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Byung-Chul
BC
Chang
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Dong Jin
DJ
Im
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yun Jung
YJ
Kim
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yoo Jin
YJ
Hong
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Geu-Ru
GR
Hong
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Electronic address: dryj@yuhs.ac.
Young Jin
YJ
Kim
D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
computed tomography; functional mitral stenosis; mitral valve repair; pannus; ring annuloplasty