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Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography.

Ender J, Eibel S, Mukherjee C, Mathioudakis D, Borger MA, Jacobs S, Mohr FW, Falk V - Eur J Echocardiogr (2011)

Bottom Line: In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively.The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75.The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany. joerg.ender@medizin.uni-leipzig.de

ABSTRACT

Aims: We sought to investigate the additional value of real-time three-dimensional transoesophageal echocardiography (RT 3D TOE)-guided sizing for predicting annuloplasty ring size during mitral valve repair.

Methods and results: In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively. The digitally stored loops were imported into a software for mitral valve assessment. The annuloplasty ring size was predicted by superimposing computer-aided design (CAD) models of annuloplasty rings onto Live 3D zoom loops, measurement of the intercommissural distance, or the height of the anterior mitral leaflet. The surgeon implanted the annuloplasty ring according to the usual surgical technique and was blinded to the echocardiographic measurement results. Pre-operative correlation between the selected ring size with mitral valve assessment and the actual implanted annuloplasty ring size was 0.91. The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75. The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height.

Conclusion: Superimposition of annuloplasty ring CAD models on the Live 3D zoom loops of the mitral valve using mitral valve assessment is superior to two-dimensional measurements of the intercommissural distance or the height of the anterior mitral leaflet in predicting correct annuloplasty ring size.

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Superimposed computer-assisted design model (yellow) on a post-operative three-dimensional loop of the native mitral valve along with the implanted annuloplasty ring.
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JER042F6: Superimposed computer-assisted design model (yellow) on a post-operative three-dimensional loop of the native mitral valve along with the implanted annuloplasty ring.

Mentions: After the annuloplasty ring was implanted, a validation protocol was performed post-cardiopulmonary bypass. A second 3D examination was performed, and the echo investigator was blinded to the actual size of the implanted ring. The modified 4D Valve Assessment® software was used to determine the size of the annuloplasty ring by superimposing the computerized ring models over the actual implanted ring. The implanted annuloplasty ring was visualized either in a 3D loop or in three 2D planes derived from the 3D model. In addition, the size of the annuloplasty ring based on the 2D measurements of the outer ring diameter as well as the height of the anterior mitral leaflet was compared with the actual implanted ring size (Figure 5). The size of the selected computerized annuloplasty ring was compared afterwards with the size of the actual implanted ring (Figure 6).Figure 5


Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography.

Ender J, Eibel S, Mukherjee C, Mathioudakis D, Borger MA, Jacobs S, Mohr FW, Falk V - Eur J Echocardiogr (2011)

Superimposed computer-assisted design model (yellow) on a post-operative three-dimensional loop of the native mitral valve along with the implanted annuloplasty ring.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117468&req=5

JER042F6: Superimposed computer-assisted design model (yellow) on a post-operative three-dimensional loop of the native mitral valve along with the implanted annuloplasty ring.
Mentions: After the annuloplasty ring was implanted, a validation protocol was performed post-cardiopulmonary bypass. A second 3D examination was performed, and the echo investigator was blinded to the actual size of the implanted ring. The modified 4D Valve Assessment® software was used to determine the size of the annuloplasty ring by superimposing the computerized ring models over the actual implanted ring. The implanted annuloplasty ring was visualized either in a 3D loop or in three 2D planes derived from the 3D model. In addition, the size of the annuloplasty ring based on the 2D measurements of the outer ring diameter as well as the height of the anterior mitral leaflet was compared with the actual implanted ring size (Figure 5). The size of the selected computerized annuloplasty ring was compared afterwards with the size of the actual implanted ring (Figure 6).Figure 5

Bottom Line: In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively.The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75.The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany. joerg.ender@medizin.uni-leipzig.de

ABSTRACT

Aims: We sought to investigate the additional value of real-time three-dimensional transoesophageal echocardiography (RT 3D TOE)-guided sizing for predicting annuloplasty ring size during mitral valve repair.

Methods and results: In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively. The digitally stored loops were imported into a software for mitral valve assessment. The annuloplasty ring size was predicted by superimposing computer-aided design (CAD) models of annuloplasty rings onto Live 3D zoom loops, measurement of the intercommissural distance, or the height of the anterior mitral leaflet. The surgeon implanted the annuloplasty ring according to the usual surgical technique and was blinded to the echocardiographic measurement results. Pre-operative correlation between the selected ring size with mitral valve assessment and the actual implanted annuloplasty ring size was 0.91. The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75. The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height.

Conclusion: Superimposition of annuloplasty ring CAD models on the Live 3D zoom loops of the mitral valve using mitral valve assessment is superior to two-dimensional measurements of the intercommissural distance or the height of the anterior mitral leaflet in predicting correct annuloplasty ring size.

Show MeSH