TY - JOUR
T1 - Mitral Valve Coaptation Reserve Index
T2 - A Model to Localize Individual Resistance to Mitral Regurgitation Caused by Annular Dilation
AU - Jainandunsing, Jayant S.
AU - Massari, Dario
AU - Vos, Jaap Jan
AU - Wijdh-den Hamer, Inez J.
AU - van den Heuvel, Ad FM
AU - Mariani, Massimo A.
AU - Mahmood, Feroze
AU - Bouma, Wobbe
AU - Scheeren, Thomas W.L.
N1 - Funding Information:
Thomas W.L. Scheeren received research grants and honoraria from Edwards Lifesciences and Masimo Inc for consulting and lecturing (all payments made to institution). Massimo A. Mariani is a consultant (theoretical and practical training activities and development of new technologies) for Artivion, Atricure, CorCym, and Medtronic. Grants were received from Abbott, Atricure, Getinge, and Edwards.
Publisher Copyright:
© 2022 The Authors
PY - 2023/5
Y1 - 2023/5
N2 - Objectives: The objective of this study was to develop a mathematical model for mitral annular dilatation simulation and determine its effects on the individualized mitral valve (MV) coaptation reserve index (CRI).Design: A retrospective analysis of intraoperative transesophageal 3-dimensionalechocardiographic MV datasets was performed. A mathematical model was created to assess the mitral CRI for each leaflet segment (A1-P1, A2-P2, A3-P3). Mitral CRI was defined as the ratio between the coaptation reserve (measured coaptation length along the closure line) and an individualized correction factor. Indexing was chosen to correct for MV sphericity and area of largest valve opening. Mathematical models were created to simulate progressive mitral annular dilatation and to predict the effect on the individual mitral CRI.Setting: At a single-center academic hospital.Participants: Twenty-five patients with normally functioning MVs undergoing cardiac surgery.Interventions: None.Measurements and Main Results: Direct measurement of leaflet coaptation along the closure line showed the lowest amount of coaptation (reserve) near the commissures (A1-P1 0.21 ± 0.05 cm and A3-P3 0.22 ± 0.06 cm), and the highest amount of coaptation (reserve) at region A2 to P2 0.25 ± 0.06 cm. After indexing, the A2-to-P2 region was the area with the lowest CRI in the majority of patients, and also the area with the least resistance to mitral regurgitation (MR) occurrence after simulation of progressive annular dilation.Conclusions: Quantification and indexing of mitral coaptation reserve along the closure line are feasible. Indexing and mathematical simulation of progressive annular dilatation consistently showed that indexed coaptation reserve was lowest in the A2-to-P2 region. These results may explain why this area is prone to lose coaptation and is often affected in MR.
AB - Objectives: The objective of this study was to develop a mathematical model for mitral annular dilatation simulation and determine its effects on the individualized mitral valve (MV) coaptation reserve index (CRI).Design: A retrospective analysis of intraoperative transesophageal 3-dimensionalechocardiographic MV datasets was performed. A mathematical model was created to assess the mitral CRI for each leaflet segment (A1-P1, A2-P2, A3-P3). Mitral CRI was defined as the ratio between the coaptation reserve (measured coaptation length along the closure line) and an individualized correction factor. Indexing was chosen to correct for MV sphericity and area of largest valve opening. Mathematical models were created to simulate progressive mitral annular dilatation and to predict the effect on the individual mitral CRI.Setting: At a single-center academic hospital.Participants: Twenty-five patients with normally functioning MVs undergoing cardiac surgery.Interventions: None.Measurements and Main Results: Direct measurement of leaflet coaptation along the closure line showed the lowest amount of coaptation (reserve) near the commissures (A1-P1 0.21 ± 0.05 cm and A3-P3 0.22 ± 0.06 cm), and the highest amount of coaptation (reserve) at region A2 to P2 0.25 ± 0.06 cm. After indexing, the A2-to-P2 region was the area with the lowest CRI in the majority of patients, and also the area with the least resistance to mitral regurgitation (MR) occurrence after simulation of progressive annular dilation.Conclusions: Quantification and indexing of mitral coaptation reserve along the closure line are feasible. Indexing and mathematical simulation of progressive annular dilatation consistently showed that indexed coaptation reserve was lowest in the A2-to-P2 region. These results may explain why this area is prone to lose coaptation and is often affected in MR.
KW - coaptation
KW - echocardiography
KW - mitral regurgitation
KW - mitral valve
KW - mitral valve coaptation reserve index
U2 - 10.1053/j.jvca.2022.11.009
DO - 10.1053/j.jvca.2022.11.009
M3 - Article
C2 - 36509635
AN - SCOPUS:85147025146
SN - 1053-0770
VL - 37
SP - 690
EP - 697
JO - Journal of cardiothoracic and vascular anesthesia
JF - Journal of cardiothoracic and vascular anesthesia
IS - 5
ER -