Three-dimensional echocardiographic evaluation of configuration and dynamics of the mitral annulus in patients fitted with an annuloplasty ring

Background and aims of the study: Three-dimensional (3D) echocardiography permits the objective analysis of structures and of pathologic conditions of complex geometry. Multiplane transesophageal echocardiography (TEE) permits 3D image sets of the heart to be produced from multiple 2D images by rotating the transducer, without changing its position. The purpose of this study was to clarify the capability of 3D echocardiography to evaluate the configuration and dynamics of the mitral annulus in patients fitted with an annuloplasty ring. Methods: Twenty patients who underwent mitral valve repair for pure mitral regurgitation (10 with a flexible Duran ring and 10 with a rigid Carpentier ring) were studied. Using a multiplane transesophageal probe, sequential tomographic images were obtained by rotating the transducer at 20 angular intervals around a 180 degrees are. 3D reconstructions were performed to produce dynamic 3D images of the mitral annulus in a manner that simulated visualization from the left atrium. Mitral annular configuration was assessed from volume-rendered display and extractive 3D imaging. Mitral annular area change was evaluated from selected long-axis cut planes. Results: The configuration and dynamics of the mitral annulus were visualized by 3D displays. In patients with a Duran ring, the mitral annulus had a non-planar configuration and mitral annular area changed during cardiac cycle (increased in diastole; reduced in atrial and ventricular systole; percentage reduction 25 +/- 2%). In patients with a Carpentier ring, the mitral annulus had a planar configuration and mitral annular area was effectively unchanged during the cardiac cycle. Conclusions: 3D echocardiography using a multiplane transesophageal probe is useful in evaluating the configuration and dynamics of the mitral annulus in patients fitted with an annuloplasty ring.