Assessment of D-Shaped Annulus of Mitral Valve in Patients with Severe MR Using Semi-Automated 4-Dimensional Analysis: Implications for Transcatheter Interventions.

Nina Ajmone Marsan,N Mai Vo,Jeroen J Bax,Victoria Delgado,Suzanne E Van Wijngaarden

doi:10.3390/jcdd7040048

Nina Ajmone Marsan, N Mai Vo + Show 3 more

Open Access

https://doi.org/10.3390/jcdd7040048

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Abstract

The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral valve annulus dimensions was evaluated. 3DTEE data of patients with moderate–severe mitral regurgitation (MR) were postprocessed with semi-automated, vendor-independent (VI) software and vendor-specific (VS) software. Both post-processing software provided key measurements for the selection of transcatheter valve prosthesis size: annulus area, annulus circumference and the septal-to-lateral distance of the annulus. The intertrigonal distance was provided only by the VS software. The inter- and intra-observer agreements were assessed with Bland–Altman analysis. Of 105 patients (63.8 ± 11 years, 66% male) with MR, 28 had secondary MR, 45 fibroelastic deficiency, and 32 Barlow’s disease. Using VS software, the dimensions for the overall population were 16.1 ± 4.6 cm2 for annulus area, for circumference 14.4 ± 1.9 cm, intertrigonal distance 3.4 ± 0.5 cm and septal-to-lateral distance 3.8 ± 0.6 cm. Similar dimensions were obtained using VI software: 15.7 ± 4.6 cm2 for annulus area, 14.5 ± 2.0 cm for circumference, and 4.1 ± 0.6 cm for septal-to-lateral distance. The inter- and intra-observer agreement for both software programs was excellent. In conclusion, current post-processing software programs for 3DTEE data of the mitral valve annulus provide good reproducibility of key measurements to select the transcatheter prosthesis size.

Highlights

The development and success of transcatheter mitral valve implantation requires accurate imaging modalities to characterize the mitral valve anatomy and geometry
Within primary mitral regurgitation (MR), the various phenotypes lead to significant variations in mitral valve geometry and dynamics: patients with Barlow’s disease (BD) showed larger mitral annular dimensions than patients with fibroelastic deficiency (FED) [3,4]
In this study we evaluated the agreement between two semi-automated postprocessing data software programs that measure the annulus of the mitral valve in a standardized approach and investigated the difference between secondary MR, BD and FED

Summary

Introduction

The development and success of transcatheter mitral valve implantation requires accurate imaging modalities to characterize the mitral valve anatomy and geometry. Unlike the aortic valve, which is rigid and most often circular, the mitral valve has an asymmetric and more flexible annulus that challenges the design of the transcatheter mitral valve prostheses [1]. The mitral annular dimensions and dynamics change according to the underlying mechanisms of mitral regurgitation (MR). In secondary MR, the mitral annulus is more rigid and has smaller dimensions than that of patients with primary MR [2]. Within primary MR, the various phenotypes lead to significant variations in mitral valve geometry and dynamics: patients with Barlow’s disease (BD) showed larger mitral annular dimensions than patients with fibroelastic deficiency (FED) [3,4]

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