Published Online
on December 2, 2008

A more recent version of this article appeared on January 1, 2009

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Original Article

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Federico Veronesi¹; Cristiana Corsi²; Lissa Sugeng³; Victor Mor-Avi³; Enrico G. Caiani⁴; Lynn Weinert³; Claudio Lamberti² and Roberto M. Lang^3,5

¹ University of Bologna and Politecnico di Milano;
² University of Bologna;
³ University of Chicago Medical Center;
⁴ Polytechnic of Milan

⁵ E-mail: rlang{at}medicine.bsd.uchicago.edu

Background—Mitral and aortic valves are known to be coupled via fibrous tissue connecting the two annuli. Previous studies evaluating this coupling have been limited to experimental animals using invasive techniques. The new matrix array transesophageal (mTEE) transducer provides high resolution real-time 3D images of both valves simultaneously. We sought to develop and test a technique for quantitative assessment of mitral and aortic valve dynamics and coupling.

Methods and Results—mTEE (Philips iE33) imaging was performed in 24 patients with normal valves undergoing clinically indicated TEE. Custom software was used to detect and track the mitral and aortic annuli (MA, AoA) in 3D space throughout the cardiac cycle, allowing automated measurement of changes in mitral and aortic valve morphology. MA surface area and AoA projected area changed reciprocally over time. MA surface area was 8.0±2.1 cm²; at end-diastole and decreased to 7.7±2.1 cm²; in systole, reaching its maximum (10.0±2.2 cm²) at mitral valve opening. AoA projected area was 4.1&±1.2 cm²; at end-diastole, then increased during isovolumic contraction reaching its maximum (4.8±1.3 cm²;) in the first third of systole, and its minimum (3.6±1.0 cm²;) during isovolumic relaxation. MA-AoA angle was maximal (136±13°) at end-diastole and decreased to its minimum value (129±11°) during systole.

Conclusions—This is the first study to report quantitative 3D assessment of the mitral and aortic valve dynamics from mTEE images and describe the mitral-aortic coupling in a beating human heart. This ability may have impact on patient evaluation for valvular surgical interventions and prosthesis design.

Key Words: imaging • mitral valve • 3D echocardiography • aortic valve • aortic-mitral valve coupling

Related Article

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Federico Veronesi, Cristiana Corsi, Lissa Sugeng, Victor Mor-Avi, Enrico G. Caiani, Lynn Weinert, Claudio Lamberti, and Roberto M. Lang
Circ Cardiovasc Imaging 2009 2: 24-31. [Abstract] [Full Text] [PDF]