Cardiac Magnetic Resonance Analysis of Mitral Annular Dynamics after Mitral Valve Repair

Ahmad A Abdouni,Carlos M.A Brandão,Carlos E Rochitte,Pablo M.A Pomerantzeff,Elinthon T Veronese,Ariane B Pacheco,Antonio S Santis,Flávio Tarasoutchi,Fábio B Jatene

doi:10.6061/clinics/2020/e2428

Ahmad A Abdouni, Carlos M.A Brandão + Show 7 more

Open Access

https://doi.org/10.6061/clinics/2020/e2428

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Abstract

OBJECTIVES:The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR).METHODS:Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively.RESULTS:We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p<0.001). The mean maximum area of the MA was significantly reduced from 14.34±4.03 to 10.45±3.17 cm2 when comparing the immediate postoperative period and the 2 year follow-up (p<0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53±3.68 cm2 to 9.23±2.84 cm2 in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up.CONCLUSION:We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.

Highlights

Mitral valve repair (MVR) is the treatment of choice for degenerative mitral regurgitation, presenting lower rates of thromboembolism and endocarditis, reduced need for anticoagulation, excellent survival and durability in long-term follow-up, and better left ventricular function, when compared with mitral valve (MV) replacement [1].Recent studies have demonstrated that cardiac magnetic resonance (CMR) can accurately demonstrate variations in measurements and shape of the mitral annulus (MA) during the cardiac cycle [2,3].There is little data in the literature regarding the remodeling and dynamics of the mitral annulus during the postoperative period of MVR
The remaining 28 patients were clinically reassessed at 6 months, 1 year, and 2 years postoperatively, when the follow-up CMR analysis was performed
One patient presented with complete atrioventricular block 18 months after surgery and underwent pacemaker implantation

Summary

Introduction

Recent studies have demonstrated that cardiac magnetic resonance (CMR) can accurately demonstrate variations in measurements and shape of the mitral annulus (MA) during the cardiac cycle [2,3]. There is little data in the literature regarding the remodeling and dynamics of the mitral annulus during the postoperative period of MVR. Received for publication on September 15, 2020. Accepted for publication on September 24, 2020

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