title: Regional Heterogeneity in the Mitral Valve Apparatus in Patients With Ischemic Mitral Regurgitation.
abstract: BACKGROUND
  Apical displacement of the coaptation point of the mitral valve (MV) in response to ischemic mitral regurgitation (IMR) represents remodeling of the MV apparatus. Whereas it implies chronicity, it lacks specificity in discriminating normal from a significantly remodeled MV apparatus. Regional aspects of MV remodeling have shown superior value over global remodeling in predicting recurrence after MV repair for IMR. Quite possibly, presence of specific regional changes in MV geometry that are unique to chronic IMR patients could also be used to diagnose the presence and track progression of remodeling. Knowledge of these changes in MV apparatus in patients with IMR can possibly be used to identify patients for surgical intervention before irreversible remodeling occurs.
  
  
  METHODS
  Three-dimensional transesophageal echocardiographic data were collected from patients who underwent MV surgery for IMR (IMR group, n = 66), and from patients with normal valvular and biventricular function (control group, n = 10). The acquired data of the MV were geometrically analyzed to make regional comparisons between the IMR and the control group to identify measurements that reliably differentiate normal from remodeled MVs.
  
  
  RESULTS
  Lengthening of the middle potion of the anterior annulus (A2 regional perimeter: 11.149 mm versus 9.798 mm, p = 0.0041), larger nonplanarity angle (147.985 versus 140.720 degrees, p = 0.0459), and increased tenting angle of the posteromedial scallop of the posterior leaflet (P3 tenting angle: 44.354 versus 40.461 degrees, p = 0.0435) were sufficient in differentiating between IMR and the control group.
  
  
  CONCLUSIONS
  Specific three-dimensional changes in MV geometry can be used to reliably identify a significantly remodeled valve apparatus.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ziyad O
authors.initials: ZO
authors.lastname: Knio
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia and Pain Medicine, University of Groningen, University Medical Center, Groningen, Netherlands.
authors.forename: Lu
authors.initials: L
authors.lastname: Yeh
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rabia
authors.initials: R
authors.lastname: Amir
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Azad
authors.initials: A
authors.lastname: Mashari
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: kkhabbaz@bidmc.harvard.edu.
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007511:Ischemia / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology