Dynamic Annular Modeling of the Unrepaired Complete Atrioventricular Canal Annulus.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
18
10
2020
revised:
03
12
2020
accepted:
09
12
2020
pubmed:
29
12
2020
medline:
4
2
2022
entrez:
28
12
2020
Statut:
ppublish
Résumé
Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the 3-dimensional (3D) structure of the atrioventricular canal annulus before repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has been neither quantified nor rigorously compared with a normal mitral valve annulus. The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared with the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis). The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height-to-valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases (P < .001). The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height-to-valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.
Sections du résumé
BACKGROUND
Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the 3-dimensional (3D) structure of the atrioventricular canal annulus before repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has been neither quantified nor rigorously compared with a normal mitral valve annulus.
METHODS
The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared with the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis).
RESULTS
The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height-to-valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases (P < .001).
CONCLUSIONS
The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height-to-valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.
Identifiants
pubmed: 33359720
pii: S0003-4975(20)32158-5
doi: 10.1016/j.athoracsur.2020.12.013
pmc: PMC8219815
mid: NIHMS1657426
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
654-662Subventions
Organisme : NHLBI NIH HHS
ID : K01 HL141643
Pays : United States
Organisme : NIBIB NIH HHS
ID : R01 EB021396
Pays : United States
Organisme : NHLBI NIH HHS
ID : F30 HL142138
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL153166
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG1 HL135683
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG1 HL135685
Pays : United States
Organisme : NHLBI NIH HHS
ID : U24 HL135691
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL068270
Pays : United States
Informations de copyright
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Références
J Biomech Eng. 2019 Apr 20;:
pubmed: 31004145
J Am Soc Echocardiogr. 2017 Jun;30(6):561-571
pubmed: 28391001
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2526-31
pubmed: 25125206
J Am Soc Echocardiogr. 2019 May;32(5):655-666.e13
pubmed: 30826226
Ann Thorac Surg. 2014 Jan;97(1):71-7
pubmed: 24090576
J Appl Physiol (1985). 2005 Aug;99(2):445-57
pubmed: 15557009
Circulation. 2010 Mar 30;121(12):1423-31
pubmed: 20231533
Circulation. 2002 Aug 6;106(6):711-7
pubmed: 12163432
J Thorac Cardiovasc Surg. 2007 Dec;134(6):1562-8
pubmed: 18023684
Circulation. 2013 Feb 19;127(7):832-41
pubmed: 23266859
Eur J Cardiothorac Surg. 2014 Apr;45(4):610-7
pubmed: 24057432
J Cardiothorac Vasc Anesth. 2014 Feb;28(1):18-24
pubmed: 24011875
Magn Reson Imaging. 2012 Nov;30(9):1323-41
pubmed: 22770690
Anesth Analg. 2015 Jul;121(1):34-58
pubmed: 26086507
Circulation. 2012 Sep 11;126(11 Suppl 1):S183-8
pubmed: 22965981
Eur J Cardiothorac Surg. 2012 Sep;42(3):493-9
pubmed: 22351705
J Am Soc Echocardiogr. 2018 Nov;31(11):1168-1177.e1
pubmed: 30098871
Ann Thorac Surg. 2020 Sep;110(3):969-978
pubmed: 32088289
Ann Thorac Surg. 2009 Jun;87(6):1872-7; discussion 1877-8
pubmed: 19463612
J Card Surg. 2013 Nov;28(6):756-63
pubmed: 24224745
J Am Soc Echocardiogr. 2012 Nov;25(11):1231-44
pubmed: 23022090
J Thorac Cardiovasc Surg. 2012 May;143(5):1117-24
pubmed: 22078711