Quantitative assessment of the effects of annuloplasty on mitral annulus dynamic geometry using real-time 3D echocardiography

Mitral valve (MV) repair is the preferred treatment for mitral regurgitation associated with organic MV prolapse (MVP). Our goal was to describe the dynamic changes in mitral annulus (MA) geometry after annuloplasty, using custom software for MA tracking from transthoracic real-time 3D echocardiography (RT3DE). Forty-four MVP patients, divided into 2 subgroups (RIG and FLEX), were studied by RT3DE the day before, at 3 and 6 months after surgery. RT3DE was also obtained in 20 normal (NL) subjects. MA was tracked frame-by-frame and several parameters were computed. As expected, MVP had an enlarged MA and a reduced planarity compared to NL. Annuloplasty resulted in reduced area both in RIG and FLEX and in a more planar MA shape. Interestingly, at 3 and 6 months, FLEX height was greater than RIG, due to different ring design. This analysis gives new insights in the in-vivo performance of the implanted rings, offering a new tool in the clinical decision process and follow-up.