Federico Sosa MD, Presenter: Nothing to Disclose

Adnaan Moin MD, Abstract Co-Author: Nothing to Disclose

Jean Jeudy MD, Abstract Co-Author: Nothing to Disclose

Seth Jay Kligerman MD, Abstract Co-Author: Author, Amirsys, Inc Research Grant, Riverain Medical

Elizabeth Kristine Weihe MD, Abstract Co-Author: Nothing to Disclose

Glenn Steven Andrews MD, Abstract Co-Author: Nothing to Disclose

Charles S. White MD, Abstract Co-Author: Research Grant, Riverain Medical

James Gammie MD, Abstract Co-Author: Nothing to Disclose

An estimated 2.5 million Americans are affected by mitral regurgitation with over 300,000 individuals undergoing surgical mitral valve repair (MVR) every year. Measurement of the intertrigonal distance (ITD) is a method to predict the size of the annuloplasty ring (AR) needed for repair. This study assesses the utility of MR in calculating this predictive parameter.

Seventeen patients with mitral regurgitation had cardiac MR (CMR) in preparation for surgery. The observed ITD (oITD) of the mitral valve was measured in short axis using a gradient echo sequence (5 mm slice thickness) during systole as the distance between the right and left trigones. The aortic annulus (AA) was measured in the 3-chamber view at mid systole. With this, an estimated ITD (eITD) was derived (eITD = AA/0.8). Using a nomogram, the predicted AR size was calculated from the oITD and eITD each. The size of the actual AR was recorded from the surgical report. T-test and Chi –square were used for statistical analysis.

Mean age was 60.1 ± 13.7 years, 10 (58.8%) patients were females. Mean regurgitant fraction and volume by CMR were 44.5 % ± 18.2 % and 60.7 ml ± 57.3 ml respectively. 7 (41.2%) cases were qualitatively classified as moderate, 2 (11.8%) as moderate-severe and 8 (47%) as severe by echocardiography. The observed ITD was 28.4 mm ± 2.8 mm and eITD was 26.9 mm ± 2.1 mm (p = 0.1, r = -0.11 – p = 0.687). The mode of the AR size used in surgery was 30 mm (26-40), the estimated AR size for oITD was 28 mm (28 – 38) (p = 0.003, r = 0.82 – p ˂ 0.001; male p = 0.087, r = 0.76 – p = 0.048; female p = 0.015, r = 0.71 – p 0.02) and the estimated AR size for eITD was 28 mm (24 – 33) (p = .536, r =0.192 – p = 0.460; male p = 0.320, r = -0.31 – p = 0.492; female p = 0.77, r = 0.18 – p = 0.627).  

The oITD measured by cardiac MR is a significant predictor of AR size, particularly in males.

Mitral Valve Intertrigonal Distance measure by CMR can predict the annuloplasty ring size and can help in planning of Mitral Valve surgery.

Sosa, F, Moin, A, Jeudy, J, Kligerman, S, Weihe, E, Andrews, G, White, C, Gammie, J, Mitral Valve Intertrigonal Distance Assessed by CMR as a Predictor of Annuloplasty Ring Size.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043706.html