Abstract
Objective
Mitral annular structure and dynamics after mitral ring annuloplasty using transesophageal echocardiography during the operation have been reported. We evaluated mitral annular structure and dynamics of three different rings in the mid-term period postoperatively.
Methods
Thirty-one patients underwent mitral valve repair for degenerative mitral insufficiency. The MEMO 3D ring (semi-flexible), Carpentier–Edwards Physio II ring (semi-rigid), and St. Jude Medical Rigid Saddle Ring (rigid) were implanted in 15, 12, and eight patients, respectively, from September 2009 to February 2015. Electrocardiogram-gated three-dimensional computed tomography was performed in the mid-term period postoperatively.
Results
The postoperative antero-posterior rate of reduction in diameter from end-diastole to end-systole was slightly larger in the MEMO3D (0.57 ± 0.69%) than in the Physio II (0.08 ± 0.60%) and Rigid Saddle Ring (0.11 ± 0.59%). There was no significant difference in the commissure-to-commissure rate of reduction in diameter among the groups. The postoperative end-systolic annular height to commissure width ratio was significantly larger in the Physio II (20.4 ± 1.7%) and Rigid Saddle Ring (21.3 ± 1.7%) than in the MEMO3D (10.8 ± 3.1%, both p < 0.0001). The rate of increase in the postoperative annular height to commissure width ratio from end-diastole to end-systole was significantly larger in the MEMO3D (2.1 ± 1.7%) than in the Physio II (0.1 ± 0.4%) and Rigid Saddle Ring (0.1 ± 0.6%).
Conclusions
The Physio II and Rigid Saddle Ring can restore the physiological and three-dimensional annular shape, and the MEMO3D can preserve physiological annular dynamics in mid-term period postoperatively.
Similar content being viewed by others
References
Levine A, Triulzi O, Harrigan P, Weyman E. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation. 1987;75:756–67.
Salgo IS, Gorman JH, Gorman RC, Jackson BM, Bowen FW, Plappert T, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation. 2002;106:711–7.
Kvitting JP, Bothe W, Göktepe S, Rausch MK, Swanson JC, Kuhl E, et al. Anterior mitral leaflet curvature during the cardiac cycle in the normal ovine heart. Circulation. 2010;122:1683–9.
Dagum P, Timek T, Green GR, Daughters GT, Liang D, Ingels NB, et al. Three-dimensional geometric comparison of partial and complete flexible mitral annuloplasty rings. J Thorac Cardiovasc Surg. 2001;122:665–73.
Jensen MO, Jensen H, Levine RA, Yoganathan AP, Andersen NT, Nygaard H, et al. Saddle-shaped mitral valve annuloplasty rings improve leaflet coaptation geometry. J Thorac Cardiovasc Surg. 2011;142:697–703.
Padala M, Hutchison RA, Croft LR, Jimenez JH, Gorman RC, Gorman JH, et al. Saddle shape of the mitral annulus reduces systolic strains on the P2 segment of the posterior mitral leaflet. Ann Thorac Surg. 2009;88:1499–504.
Ryan LP, Jackson BM, Hamamoto H, Eperjesi TJ, Plappert TJ, St John-Sutton M, et al. The influence of annuloplasty ring geometry on mitral leaflet curvature. Ann Thorac Surg. 2008;86:749–60 (discussion 749–760).
Ryomoto M, Mitsuno M, Yamamura M, Tanaka H, Fukui S, Tsujiya N, et al. Is physiologic annular dynamics preserved after mitral valve repair with rigid or semirigid ring? Ann Thorac Surg. 2014;97:492–7.
Bothe W, Kvitting JP, Swanson JC, Hartnett S, Ingels NB, Miller DC. Effects of different annuloplasty rings on anterior mitral leaflet dimensions. J Thorac Cardiovasc Surg. 2010;139:1114–22.
Bothe W, Kuhl E, Kvitting JP, Rausch MK, Göktepe S, Swanson JC, et al. Rigid, complete annuloplasty rings increase anterior mitral leaflet strains in the normal beating ovine heart. Circulation. 2011;124:S81–96.
Jensen MO, Jensen H, Smerup M, Levine RA, Yoganathan AP, Nygaard H, et al. Saddle-shaped mitral valve annuloplasty rings experience lower forces compared with flat rings. Circulation. 2008;118:S250–5.
Vergnat M, Jackson BM, Cheung AT, Weiss SJ, Ratcliffe SJ, Gillespie MJ, et al. Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet. Ann Thorac Surg. 2011;92:797–803.
Mahmood F, Gorman JH, Subramaniam B, Gorman RC, Panzica PJ, Hagberg RC, et al. Changes in mitral valve annular geometry after repair: saddle-shaped versus flat annuloplasty rings. Ann Thorac Surg. 2010;90:1212–20.
Nishi H, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Kawamura M, et al. Annular dynamics after mitral valve repair with different prosthetic rings: a real-time three-dimensional transesophageal echocardiography study. Surg Today. 2016;46:1083–90.
Tsuneto A, Eishi K, Miura T, Tanigawa K, Matsukuma S, Minami T, et al. Comparison of saddle-shape flexibility and elliptical-shape stability between Cosgrove–Edwards and Memo-3D annuloplasty rings using three-dimensional analysis software. Gen Thorac Cardiovasc Surg. 2016;64:325–32.
Grewal J, Suri R, Mankad S, Tanaka A, Mahoney DW, Schaff HV, et al. Mitral annular dynamics in myxomatous valve disease: new insights with real-time three-dimensional echocardiography. Circulation. 2010;121:1423–31.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflict of interest.
Rights and permissions
About this article
Cite this article
Ryomoto, M., Mitsuno, M., Yamamura, M. et al. Physiological mitral annular dynamics preserved after ring annuloplasty in mid-term period. Gen Thorac Cardiovasc Surg 65, 627–632 (2017). https://doi.org/10.1007/s11748-017-0805-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-017-0805-x