Skip to main content
×
Home
    • Aa
    • Aa

A multiplanar three dimensional echocardiographic study of mitral valvar annular function in children with normal and regurgitant valves

  • Tara Bharucha (a1), Muthukumaran C. Sivaprakasam (a1), Kevin S. Roman (a1) and Joseph J. Vettukattil (a1)
Abstract
AbstractIntroduction

The mitral valvar complex is difficult to visualise accurately in only two dimensions. Three-dimensional echocardiography gives new insight into the dynamic changes of intra-cardiac structures during the cardiac cycle. The aim of this study was to study the mitral annulus in systole and diastole in normal children using three-dimensional echocardiography, and to analyse the effect of regurgitation on annular function.

Materials and methods

Three-dimensional echocardiographic datasets, acquired in 11 consecutive subjects with mitral regurgitation, and 20 normal subjects, were analysed offline using simultaneous multiplanar review.

Results

The mitral valvar annular area decreased in diastole, and increased in systole, in both groups. The annulus in patients with mitral regurgitation is dilated compared to normal subjects, the systolic value for those with regurgitation having a mean of 6.79 plus or minus 2.55 centimetres2/metres2, and the diastolic value a mean of 5.01 plus or minus 1.78 centimetres2/metres2, as opposed to a systolic mean value of 5.28 centimetres2/metres2 plus or minus 1.68, p = 0.091, and diastolic mean value of 3.05 centimetres2/metres2 plus or minus 0.90, in normal subjects (p less than 0.0001). The proportional change in mitral valvar annular area from systole to diastole showed a trend towards being smaller in those with mitral regurgitation, although this did not reach significance (24.8% versus 41.13%, p equal to 0.249). Analysis of subgroups of patients with moderate or severe mitral regurgitation showed mitral excursion, expressed as percentage of left ventricular length, to be significantly less than in normal subjects, at 12.78 plus or minus 5.10% versus 15.84 plus or minus 4.23% (p equal to 0.012).

Conclusions

Mitral valvar annular area in children decreases in diastole, and increases in systole. In those with mitral regurgitation, the annulus is dilated and the dynamic annular function is depressed.

Copyright
Corresponding author
Correspondence to: Dr J. Vettukattil, Department of Paediatric Cardiology, Wessex Cardiothoracic Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. Tel: +44 (0)23 8079 6944; Fax: (0)23 8079 4526; E-mail: joseph.vettukattil@suht.swest.nhs.uk
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2. R Applebaum , R Kasliwal , A Kanojia , Utility of three-dimensional echocardiography during balloon mitral valvuloplasty. J Am Coll Cardiol 1998; 32: 14051409.

3. J Li , SP Sanders . Three-dimensional echocardiography in congenital heart disease. Curr Opin Cardiol 1999; 14: 5359.

4. SR Kaplan , G Basheim , FH Sheehan , Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve. Am Heart J 2000; 139: 378387.

5. J Kwan , JX Qin , ZB Popovic , DA Agler , JD Thomas , T Shiota . Geometric changes of mitral annulus assessed by real-time 3-dimensional echocardiography: becoming enlarged and less nonplanar in the anteroposterior direction during systole in proportion to global left ventricular systolic function. J Am Soc Echocardiogr 2004; 17: 11791184.

6. JA Ormiston , PM Shah , C Tei , M Wong . Size and motion of the mitral valve annulus in man. II. Abnormalities in mitral valve prolapse. Circulation 1982; 65: 713719.

7. RA Levine , MD Handschumacher , AJ Sanfilippo , Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for diagnosis of mitral valve prolapse. Circulation 1989; 80: 589598.

8. JR Glasson , M Komeda , GT Daughters , Three-dimensional regional dynamics of the normal mitral annulus during left ventricular ejection. J Thorac Cardiovasc Surg 1996; 111: 574585.

9. JA Ormiston , PM Shah , C Tei , M Wong . Size and motion of the mitral valve annulus in man: I. A two-dimensional echocardographic method and findings in normal subjects. Circulation 1981; 64: 113120.

10. M Nii , KS Roman , CK Macgowan , JF Smallhorn . Insight into normal mitral and tricuspid annular dynamics in pediatrics: a real-time three-dimensional echocardiographic study. J Am Soc Echocardiogr 2005; 18: 805814.

11. SL Schwartz , QL Cao , J Azevedo , NG Pandian . Simulation of intraoperative visualization of cardiac structures and study of dynamic surgical anatomy with real-time three-dimensional echocardiography. Am J Cardiol 1994; 73: 501507.

12. Q Chen , YF Nosir , WB Vletter , PP Kint , A Salustri , JR Toelandt . Accurate assessment of mitral valve area in patients with mitral stenosis by three-dimensional echocardiography. J Am Soc Echocardiogr 1997; 10: 133140.

13. CS Breburda , BP Griffin , M Pu , LO Rodriguez , DM Cosgrove 3rd, JD Thomas . Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence. J Am Coll Cardiol 1998; 32: 432437.

16. IS Salgo , JH Gorman , RC Gorman , Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation 2002; 106: 711717.

19. JS Simonson , NB Schiller . Descent of the base of the left ventricle: an echocardiographic index of left ventricular function. J Am Soc Echocardiogr 1989; 2: 2535.

20. TA Timek , GR Green , FA Tibayan , Aorto-mitral annular dynamics. Ann Thorac Surg 2003; 76: 19441950.

21. RC Gorman , JS McCaughan , MB Ratcliffe , Pathogenesis of acute ischemic mitral regurgitation in three dimensions. J Thorac Cardiovasc Surg 1995; 109: 684693.

22. Y Otsuji , MD Handschumacher , E Schwammenthal , Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation. Circulation 1997; 96: 19992008.

23. TM Binder , R Rosehhek , G Porenta , G Maurer , H Baumgartner . Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography. J Am Coll Cardiol 2000; 36: 13551361.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: