Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2017; 9(9): 757-760
Published online Sep 26, 2017. doi: 10.4330/wjc.v9.i9.757
Geometric comparison of the mitral and tricuspid valve annulus: Insights from three dimensional transesophageal echocardiography
Amgad N Makaryus, Haisam Ismail, John N Makaryus, Dali Fan
Amgad N Makaryus, Haisam Ismail, John N Makaryus, Hofstra Northwell School of Medicine, Department of Cardiology, North Shore University Hospital, Manhasset, NY 11030, United States
Amgad N Makaryus, Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, United States
Dali Fan, Department of Medicine, Division of Cardiology, University of California, Davis, CA 95616, United States
Author contributions: Makaryus AN, Ismail H, Makaryus JN and Fan D were authors and researchers.
Institutional review board statement: This study protocol was approved by the North Shore University Hospital/Northwell Institutional Review Board and met criteria for expedited review under U.S. 45 CFR 46.110(5) for research involving materials (data, documents, records, or specimens) that have been collected, or will be collected solely for the non-research purposes (such as medical treatment or diagnosis).
Informed consent statement: This study was granted a Waiver of Consent and HIPAA Authorization by the North ShoreUniversity Hospital/Northwell Institutional Review Board.
Conflict-of-interest statement: No conflicts of Interest exist for any of the authors with respect to the publication of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amgad N Makaryus, MD, Associate Professor, Chairman, Department of Cardiology, NuHealth, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States. amakaryu@numc.edu
Telephone: +1-516-2964949
Received: February 14, 2017
Peer-review started: February 14, 2017
First decision: April 19, 2017
Revised: July 8, 2017
Accepted: July 21, 2017
Article in press: July 24, 2017
Published online: September 26, 2017
Processing time: 222 Days and 19.1 Hours
Abstract
AIM

To apply real time three-dimensional transesophageal echocardiography (RT3D TEE) for quantitative and qualitative assessment of the mitral valve annulus (MVA) and tricuspid valve annulus (TVA) in the same patient.

METHODS

Our retrospective cohort study examined the MVA and TVA in 49 patients by RT3D TEE. MVA and TVA shape were examined by TEE. The MVA and TVA volume data set images were acquired in the mid esophageal 4-chamber view. The MVA and TVA were acquired separately, with optimization of each for the highest frame rate and image quality. The 3D shape of the annuli was reconstructed using the Philips® Q lab, MVQ ver. 6.0 MVA model software. The end-systolic frame was used. The parameters measured and compared were annular area, circumference, high-low distances (height), anterolateral-posterolateral (ALPM), and anteroposterior (AP) axes.

RESULTS

A total of 49 patients (mean age 61 ± 14 years, 45% males) were studied. The ALPM and the AP axes of the MVA and TVA are not significantly different. The ALPM axis of the MVA was 37.9 ± 6.4 mm and 38.0 ± 5.6 mm for the TVA (P = 0.70). The AP axis of the MVA was 34.8 ± 5.7 mm and 34.9 ± 6.2 mm for the TVA (P = 0.90). The MVA and the TVA had similar circumference and area. The circumference of the MVA was 127.9 ± 16.8 mm and 125.92 ± 16.12 mm for the TVA (P = 0.23). The area of the MVA was 1103.7 ± 307.8 mm2 and 1131.7 ± 302.0 mm2 for the TVA (P = 0.41). The MVA and TVA are similar oval structures, but with significantly different heights. The ALPM/AP ratio for the MVA was 1.08 ± 0.33 and 1.09 ± 0.28 for the TVA (P < 0.001). The height for the MVA and TVA was 9.23 ± 2.11 mm and 4.37 ± 1.48 mm, respectively (P < 0.0001).

CONCLUSION

RT3D TEE plays an unprecedented role in the management of valvular heart disease. The specific and exclusive shape of the MVA and TVA was revealed in our study of patients studied. Moreover, the intricate codependence of the MVA and the TVA depends on their distinctive shapes. This realization seen from our study will allow us to better understand the role valvular disease plays in disease states such as hypertrophic cardiomyopathy and pulmonary hypertension.

Keywords: Mitral valve annulus; Tricuspid valve annulus; Three dimensional imaging; Real time three-dimensional transesophageal echocardiography

Core tip: Three dimensional (3D) imaging of the heart has allowed for improved understanding and delineation of cardiac structure and function. Real time three-dimensional transesophageal echocardiography (RT3D TEE) has been on the forefront of allowing this 3D imaging to be used in mainstream cardiac practice for many years. The mitral valve annulus (MVA) and the tricuspid valve annulus (TVA) are multi-component complex structures and 3D imaging has allowed better understanding of their structure. Our study aims to apply RT3D TEE for quantitative and qualitative assessment and comparison of the MVA and TVA in the same patient. Gaining an understanding of the similarities and differences between these two valves will provide a better understanding of cardiac physiology and pathophysiology and thereby hopefully lead to improvements in clinical practice.