PMID- 27530639
OWN - NLM
STAT- MEDLINE
DCOM- 20180810
LR  - 20181113
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 152
IP  - 3
DP  - 2016 Sep
TI  - The value of preoperative 3-dimensional over 2-dimensional valve analysis in
      predicting recurrent ischemic mitral regurgitation after mitral annuloplasty.
PG  - 847-59
LID - 10.1016/j.jtcvs.2016.06.040 [doi]
LID - S0022-5223(16)30670-5 [pii]
AB  - OBJECTIVES: Repair for ischemic mitral regurgitation with undersized annuloplasty
      is characterized by high recurrence rates. We sought to determine the value of
      pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in 
      predicting recurrence at 6 months. METHODS: Intraoperative transesophageal
      2-dimensional echocardiography and 3-dimensional echocardiography were performed 
      in 50 patients undergoing undersized annuloplasty for ischemic mitral
      regurgitation. Two-dimensional echocardiography annular diameter and tethering
      parameters were measured in the apical 2- and 4-chamber views. A customized
      protocol was used to assess 3-dimensional annular geometry and regional leaflet
      tethering. Recurrence (grade >/=2) was assessed with 2-dimensional transthoracic 
      echocardiography at 6 months. RESULTS: Preoperative 2- and 3-dimensional annular 
      geometry were similar in all patients with ischemic mitral regurgitation.
      Preoperative 2- and 3-dimensional leaflet tethering were significantly higher in 
      patients with recurrence (n = 13) when compared with patients without recurrence 
      (n = 37). Multivariate logistic regression revealed preoperative 2-dimensional
      echocardiography posterior tethering angle as an independent predictor of
      recurrence with an optimal cutoff value of 32.0 degrees (area under the curve,
      0.81; 95% confidence interval, 0.68-0.95; P = .002) and preoperative
      3-dimensional echocardiography P3 tethering angle as an independent predictor of 
      recurrence with an optimal cutoff value of 29.9 degrees (area under the curve,
      0.92; 95% confidence interval, 0.84-1.00; P < .001). The predictive value of the 
      3-dimensional geometric multivariate model can be augmented by adding basal
      aneurysm/dyskinesis (area under the curve, 0.94; 95% confidence interval,
      0.87-1.00; P < .001). CONCLUSIONS: Preoperative 3-dimensional echocardiography P3
      tethering angle is a stronger predictor of ischemic mitral regurgitation
      recurrence after annuloplasty than preoperative 2-dimensional echocardiography
      posterior tethering angle, which is highly influenced by viewing plane. In
      patients with a preoperative P3 tethering angle of 29.9 degrees or larger
      (especially when combined with basal aneurysm/dyskinesis), chordal-sparing valve 
      replacement should be strongly considered.
CI  - Copyright (c) 2016 The American Association for Thoracic Surgery. Published by
      Elsevier Inc. All rights reserved.
FAU - Wijdh-den Hamer, Inez J
AU  - Wijdh-den Hamer IJ
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa; Department of Cardiothoracic Surgery, University of Groningen, University
      Medical Center Groningen, Groningen, The Netherlands.
FAU - Bouma, Wobbe
AU  - Bouma W
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa; Department of Cardiothoracic Surgery, University of Groningen, University
      Medical Center Groningen, Groningen, The Netherlands.
FAU - Lai, Eric K
AU  - Lai EK
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa.
FAU - Levack, Melissa M
AU  - Levack MM
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa.
FAU - Shang, Eric K
AU  - Shang EK
AD  - Department of Surgery, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa.
FAU - Pouch, Alison M
AU  - Pouch AM
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa.
FAU - Eperjesi, Thomas J
AU  - Eperjesi TJ
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa.
FAU - Plappert, Theodore J
AU  - Plappert TJ
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa.
FAU - Yushkevich, Paul A
AU  - Yushkevich PA
AD  - Department of Radiology, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa.
FAU - Hung, Judy
AU  - Hung J
AD  - Department of Cardiology, Massachusetts General Hospital, Harvard Medical School,
      Boston, Mass.
FAU - Mariani, Massimo A
AU  - Mariani MA
AD  - Department of Cardiothoracic Surgery, University of Groningen, University Medical
      Center Groningen, Groningen, The Netherlands.
FAU - Khabbaz, Kamal R
AU  - Khabbaz KR
AD  - Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center,
      Harvard Medical School, Boston, Mass.
FAU - Gleason, Thomas G
AU  - Gleason TG
AD  - Department of Surgery, University of Pittsburgh, Pittsburgh, Pa.
FAU - Mahmood, Feroze
AU  - Mahmood F
AD  - Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical
      School, Boston, Mass.
FAU - Acker, Michael A
AU  - Acker MA
AD  - Department of Surgery, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa.
FAU - Woo, Y Joseph
AU  - Woo YJ
AD  - Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
FAU - Cheung, Albert T
AU  - Cheung AT
AD  - Department of Anesthesia, Stanford University, Stanford, Calif.
FAU - Gillespie, Matthew J
AU  - Gillespie MJ
AD  - Department of Cardiology, The Children's Hospital of Philadelphia, University of 
      Pennsylvania, Philadelphia, Pa.
FAU - Jackson, Benjamin M
AU  - Jackson BM
AD  - Department of Surgery, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa.
FAU - Gorman, Joseph H 3rd
AU  - Gorman JH 3rd
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa; Department of Surgery, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa.
FAU - Gorman, Robert C
AU  - Gorman RC
AD  - Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia,
      Pa; Department of Surgery, The Children's Hospital of Philadelphia, University of
      Pennsylvania, Philadelphia, Pa. Electronic address: gormanr@uphs.upenn.edu.
LA  - eng
GR  - R01 HL063954/HL/NHLBI NIH HHS/United States
GR  - R01 HL073021/HL/NHLBI NIH HHS/United States
GR  - R01 HL103723/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20160629
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - AIM
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2016 Sep;152(3):860-1. PMID: 27530640
MH  - Aged
MH  - *Echocardiography
MH  - *Echocardiography, Three-Dimensional
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Mitral Valve Annuloplasty
MH  - Mitral Valve Insufficiency/*diagnostic imaging/*surgery
MH  - Predictive Value of Tests
MH  - Preoperative Care
MH  - Recurrence
PMC - PMC4991641
MID - NIHMS800819
OTO - NOTNLM
OT  - *echocardiography
OT  - *ischemia
OT  - *mitral regurgitation
OT  - *mitral valve repair
COIS- Statement Authors have nothing to disclose with regard to commercial support.
EDAT- 2016/08/18 06:00
MHDA- 2018/08/11 06:00
CRDT- 2016/08/18 06:00
PHST- 2016/03/24 00:00 [received]
PHST- 2016/05/05 00:00 [revised]
PHST- 2016/06/10 00:00 [accepted]
PHST- 2016/08/18 06:00 [entrez]
PHST- 2016/08/18 06:00 [pubmed]
PHST- 2018/08/11 06:00 [medline]
AID - S0022-5223(16)30670-5 [pii]
AID - 10.1016/j.jtcvs.2016.06.040 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2016 Sep;152(3):847-59. doi:
      10.1016/j.jtcvs.2016.06.040. Epub 2016 Jun 29.