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Cardiovascular MRI derived mitral valve geometry predicts the surgical treatment of mitral regurgitation
Journal of Cardiovascular Magnetic Resonance volume 11, Article number: P145 (2009)
Mitral regurgitation (MR) is the most common valvular heart disease worldwide with varying causes. The ultimate treatment of mitral regurgitation is surgical. The surgical decision making classically depends on the symptoms, severity of MR, left ventricular dimension and function. Common mitral apparatus descriptors now serve as a 'road map' to direct surgical options.
Distinguish mitral valvar/apparati geometric patterns in pts who undergo mitral valve (MV) surgery via cardiovascular MRI (CMR).
Thirty-seven (37) pts underwent CMR (1.5 T GE). The 3D MV and ventricular geometry was analyzed by multiplanar SSFP imaging without contrast administration. The following MV parameters were measured: tenting area, tenting angle, tenting height, anterior leaflet (AL) and posterior leaflet (PL) length and annulus diameter. Pts were divided into two groups: MV surgery (MV+) and no MV surgery (MV-). The data was statically analyzed by t-test, linear regression and ANOVA.
Out of 37 pts, 18 had mild to moderate MR (1–2+) and 19 pts had moderate-severe MR (3–4+). Eight out of 37 pts underwent surgery (6 of 8 had severe 4+ MR and two were moderate 3–4+). As expected, MR severity correlated with surgical treatment (r = 0.6, p < 0.001). The AL length most strongly predicted the severity of MR (r = 0.7, p = 0.007). Tenting area and annulus diameter were higher in MV+ than in MV- (141 ± 92 vs. 106 ± 38 mm2, 34 ± 8 vs. 27 ± 4 mm, p < 0.005). However, a composite of MR degree, annular diameter and the ventricular length most strongly predicted MV surgery (r = 0.8, p < 0.001). Interestingly, in contradiction to current dogma, the tenting angle and tenting height did not predict the severity of MR or need for MV surgery. More importantly, the appearance and description of the MV on CMR study correlated well with the surgeon's description of the mitral apparatus at time of surgery (7/8 pts; 88% concordance). In 1 pt, the surgeon's description of the MV was sparse.
While many criteria have been well established to direct mitral valve surgical strategies, little has been defined by non-echocardiographic methods. Herein, CMR is shown to be concordant with the clinical need for MV surgery and independently predictive of etiology of MR as confirmed at surgery.
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Fernandes, A.M., Biederman, R.W., Doyle, M. et al. Cardiovascular MRI derived mitral valve geometry predicts the surgical treatment of mitral regurgitation. J Cardiovasc Magn Reson 11 (Suppl 1), P145 (2009). https://doi.org/10.1186/1532-429X-11-S1-P145
- Mitral Valve
- Mitral Regurgitation
- Mitral Regurgitation Severity
- Anterior Leaflet
- Posterior Leaflet