Skip to main content

Physiological mitral annular dynamics preserved after ring annuloplasty in mid-term period

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 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.

    CAS  Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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.

    CAS  Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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).

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuji Miyamoto.

Ethics declarations

Conflict of interest

All authors have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-017-0805-x

Keywords

  • Mitral valve repair
  • Annular dynamics
  • Ring annuloplasty
  • Saddle shape