on July 22, 2002
Published online before print July 22, 2002, doi: 10.1161/01.CIR.0000025426.39426.83
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on January 10, 2002
From Philips Medical Systems (I.S.S.), Andover, Mass, and the Departments of Surgery (J.H.G., R.C.G., B.M.J., F.W.B,. L.H.E.), Medicine (T.P., M.G.S.J.S.), and Anesthesia (I.S.S.), School of Medicine, University of Pennsylvania, Philadelphia, Pa. * To whom correspondence should be addressed. E-mail: ivan_salgo{at}attbi.com.
Background—Leaflet curvature is known to reduce mechanical stress. There are 2 major components that contribute to this curvature. Leaflet billowing introduces the most obvious form of leaflet curvature. The saddle shape of the mitral annulus imparts a more subtle form of leaflet curvature. This study explores the relative contributions of leaflet billowing and annular shape on leaflet curvature and stress distribution. Methods and Results—Both numerical simulation and experimental data were used. The simulation consisted of an array of numerically generated mitral annular phantoms encompassing flat to markedly saddle-shaped annular heights. Highest peak leaflet stresses occurred for the flat annulus. As saddle height increased, peak stresses decreased. The minimum peak leaflet stress occurred at an annular height to commissural width ratio of 15% to 25%. The second phase involved data acquisition for the annulus from 3 humans by 3D echocardiography, 3 sheep by sonomicrometry array localization, 2 sheep by 3D echocardiography, and 2 baboons by 3D echocardiography. All 3 species imaged had annuli of a similar shape, with an annular height to commissural width ratio of 10% to 15%. Conclusion—The saddle shape of the mitral annulus confers a mechanical advantage to the leaflets by adding curvature. This may be valuable when leaflet curvature becomes reduced due to diminished leaflet billowing caused by annular dilatation. The fact that the saddle shape is conserved across mammalian species provides indirect evidence of the advantages it confers. This analysis of mitral annular contour may prove applicable in developing the next generation of mitral annular prostheses.
Revised on May 23, 2002
Accepted on May 24, 2002
Effect of Annular Shape on Leaflet Curvature in Reducing Mitral Leaflet Stress
Ivan S. Salgo MS, MD*,
Key words: finite element analysis • echocardiography • ultrasonics • valves
This article has been cited by other articles:
 |
|
 |
|
  M. O. Jensen, H. Jensen, M. Smerup, R. A. Levine, A. P. Yoganathan, H. Nygaard, J. M. Hasenkam, and S. L. Nielsen Saddle-Shaped Mitral Valve Annuloplasty Rings Experience Lower Forces Compared With Flat Rings Circulation, September 30, 2008; 118(14_suppl_1): S250 - S255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Levine and R. Durst Mitral Valve Prolapse: A Deeper Look J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 304 - 306. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lange, T. Guenther, B. Kiefer, C. Noebauer, W. Goetz, R. Busch, P. Tassani-Prell, B. Voss, and R. Bauernschmitt Mitral valve repair with the new semirigid partial Colvin-Galloway Future annuloplasty band. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1087 - 1093.e4. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Gelsomino, R. Lorusso, I. Capecchi, C. Rostagno, S. Romagnoli, G. Bille, G. De Cicco, C. Tetta, P. Stefano, and G. F. Gensini Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation Ann. Thorac. Surg., April 1, 2008; 85(4): 1319 - 1330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato Ischemic mitral regurgitation: mechanisms and echocardiographic classification Eur J Echocardiogr, March 1, 2008; 9(2): 207 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]
|
|
|
|
|
|
J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]
|
|
|
|
|
|
J. H. Jimenez, S. W. Liou, M. Padala, Z. He, M. Sacks, R. C. Gorman, J. H. Gorman III, and A. P. Yoganathan A saddle-shaped annulus reduces systolic strain on the central region of the mitral valve anterior leaflet. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1562 - 1568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. George, E. I. Kapetanakis, K. Dhadwal, S. Al-Ruzzeh, E. Rigopoulou, M. Bulanade, T. Athanasiou, and M. Amrani A three-dimensional echocardiographic comparison of a deep pericardial stitch versus an apical suction device for heart positioning during beating heart surgery Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 604 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III Invited commentary Ann. Thorac. Surg., October 1, 2007; 84(4): 1255 - 1255. [Full Text] [PDF]
|
|
|
|
|
|
L. P. Ryan, B. M. Jackson, L. M. Parish, T. J. Plappert, M. G. St. John-Sutton, J. H. Gorman III, and R. C. Gorman Regional and Global Patterns of Annular Remodeling in Ischemic Mitral Regurgitation Ann. Thorac. Surg., August 1, 2007; 84(2): 553 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Fundaro, P. M Tartara, E. Villa, P. Fratto, S. Campisi, and E. O Vitali Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty? Asian Cardiovasc Thorac Ann, August 1, 2007; 15(4): 351 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Ratcliffe Invited commentary Ann. Thorac. Surg., July 1, 2007; 84(1): 101 - 102. [Full Text] [PDF]
|
|
|
|
|
|
T. C. Nguyen, A. Cheng, F. A. Tibayan, D. Liang, G. T. Daughters, N. B. Ingels Jr., and D. C. Miller Septal-lateral annnular cinching perturbs basal left ventricular transmural strains Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 423 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Choure, M. J. Garcia, B. Hesse, M. Sevensma, G. Maly, N. L. Greenberg, L. Borzi, S. Ellis, E. M. Tuzcu, and S. R. Kapadia In Vivo Analysis of the Anatomical Relationship of Coronary Sinus to Mitral Annulus and Left Circumflex Coronary Artery Using Cardiac Multidetector Computed Tomography: Implications for Percutaneous Coronary Sinus Mitral Annuloplasty J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1938 - 1945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Sacks, Y. Enomoto, J. R. Graybill, W. D. Merryman, A. Zeeshan, A. P. Yoganathan, R. J. Levy, R. C. Gorman, and J. H. Gorman III In-vivo dynamic deformation of the mitral valve anterior leaflet. Ann. Thorac. Surg., October 1, 2006; 82(4): 1369 - 1377. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T.-T. Ton-Nu, R. A. Levine, M. D. Handschumacher, D. J. Dorer, C. Yosefy, D. Fan, L. Hua, L. Jiang, and J. Hung Geometric Determinants of Functional Tricuspid Regurgitation: Insights From 3-Dimensional Echocardiography Circulation, July 11, 2006; 114(2): 143 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Fukuda, G. Saracino, Y. Matsumura, M. Daimon, H. Tran, N. L. Greenberg, T. Hozumi, J. Yoshikawa, J. D. Thomas, and T. Shiota Three-Dimensional Geometry of the Tricuspid Annulus in Healthy Subjects and in Patients With Functional Tricuspid Regurgitation: A Real-Time, 3-Dimensional Echocardiographic Study Circulation, July 4, 2006; 114(1_suppl): I-492 - I-498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Hashim and D. Richens Finite element method in cardiac surgery Interactive CardioVascular and Thoracic Surgery, February 1, 2006; 5(1): 5 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Gabriel, O. Kamp, and C. A. Visser Three-dimensional echocardiography in mitral valve disease Eur J Echocardiogr, December 1, 2005; 6(6): 443 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaji, M. Nasu, A. Yamamuro, K. Tanabe, K. Nagai, T. Tani, K. Tamita, K. Shiratori, M. Kinoshita, M. Senda, et al. Annular Geometry in Patients With Chronic Ischemic Mitral Regurgitation: Three-Dimensional Magnetic Resonance Imaging Study Circulation, August 30, 2005; 112(9_suppl): I-409 - I-414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, J. R. Glasson, D. T. Lai, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Annular Height-to-Commissural Width Ratio of Annulolasty Rings In Vivo Circulation, August 30, 2005; 112(9_suppl): I-423 - I-428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Watanabe, Y. Ogasawara, Y. Yamaura, N. Wada, T. Kawamoto, E. Toyota, T. Akasaka, and K. Yoshida Mitral Annulus Flattens in Ischemic Mitral Regurgitation: Geometric Differences Between Inferior and Anterior Myocardial Infarction: A Real-Time 3-Dimensional Echocardiographic Study Circulation, August 30, 2005; 112(9_suppl): I-458 - I-462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Watanabe, Y. Ogasawara, Y. Yamaura, T. Kawamoto, E. Toyota, T. Akasaka, and K. Yoshida Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography J. Am. Coll. Cardiol., March 1, 2005; 45(5): 763 - 769. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Villa, P. Fundaro, A. Moneta, and F. Donatelli Chronic Ischemic Mitral Regurgitation: Toward a Solution or Still an Enigma? Ann. Thorac. Surg., February 1, 2005; 79(2): 752 - 752. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Carlhall, L. Wigstrom, E. Heiberg, M. Karlsson, A. F. Bolger, and E. Nylander Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change Am J Physiol Heart Circ Physiol, October 1, 2004; 287(4): H1836 - H1841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, D. T. Lai, D. Liang, F. Tibayan, F. Langer, F. Rodriguez, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Effects of Paracommissural Septal-Lateral Annular Cinching on Acute Ischemic Mitral Regurgitation Circulation, September 14, 2004; 110(11_suppl_1): II-79 - II-84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part I Circulation, March 2, 2004; 109(8): 942 - 950. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, B. M. Jackson, S. L. Moainie, Y. Enomoto, and R. C. Gorman Influence of inotropy and chronotropy on the mitral valve sphincter mechanism Ann. Thorac. Surg., March 1, 2004; 77(3): 852 - 857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Tibayan, F. Rodriguez, F. Langer, M. K. Zasio, L. Bailey, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Does septal-lateral annular cinching work for chronic ischemic mitral regurgitation? J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 654 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III and R. C. Gorman Invited commentary Ann. Thorac. Surg., February 1, 2004; 77(2): 522 - 522. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, B. M. Jackson, Y. Enomoto, and R. C. Gorman The effect of regional ischemia on mitral valve annular saddle shape Ann. Thorac. Surg., February 1, 2004; 77(2): 544 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Tibayan, F. Rodriguez, F. Langer, M. K. Zasio, L. Bailey, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications Ann. Thorac. Surg., November 1, 2003; 76(5): 1549 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Tibayan, F. Rodriguez, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Paneth Suture Annuloplasty Abolishes Acute Ischemic Mitral Regurgitation but Preserves Annular and Leaflet Dynamics Circulation, September 9, 2003; 108(90101): II-128 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
|
|