162 Height of the anterior leaflet (A2), measured by echocardiography predicts accurately the annuloplasty ring size used during mitral valve reconstruction using Carpentier's techniques

Abstract

Remodeling concept annuloplasty is one of the golden rule of long term efficacy of mitral valve reconstruction using Carpentier's techniques. Sizing is a key issue to avoid undersizing (risk of SAM) or oversizing (residual MR) in degenerative mitral regurgitation (MR). There are no studies who try to predict the accurate ring annuloplasty size based upon echocardiographic measurement of the height of anterior leaflet height (A2) To establish a correlation between height of the anterior leaflet height (A2) measured by intra-operative (IOE) transesophageal echocardiography (TEE) and annuloplasty ring size measured by surgeons in type II degenerative MR. Prospective monocentric study. Measurement of the height of anterior leaflet (A2) in long axis view using multiplane IOE TEE (pre pump) and mitral annuloplasty ring size (Carpentier-Edwards Physio) measured systematically by surgeons with sizers. Intra Class Correlation test and Bland-Altman plot were done. Fifty patients were included. The mitral ring diameter was 41.4 mm +/− 3.7. The anterior leaflet height was 32.7 mm +/− 2.9. Size of annuloplasty ring was 32.8 mm +/− 2.9. The anterior leaflet height was significantly correlated with the prosthetic ring used, r = 0.869 [0.780, 0.923], p < 10–3. The mitral ring diameter was not concordant with the prosthetic ring used, r = −0.432 [−0.632,−0.178], p = 0.39. The Bland-Altman plot shows that there is a good correlation between the anterior leaflet height and the prosthetic ring used. The anterior leaflet height (A2) measured by echocardiography predicts accurately annuloplasty mitral ring size measured systematically by surgeons.Download : Download full-size imageBland-Altmann plot Bland-Altmann plot