Evaluation of Mitral Annulus Diameter by Three-Dimensional Transesophageal Echocardiography and Its Correlation with Surgical Techniques

Background: Mitral Valve (MV) disease is responsible for a considerable number of open cardiac surgeries. Selecting a befitting prosthetic valve is a matter of consideration. Thus, accurate definition of mitral apparatus characteristics, particularly mitral annulus dimensions, preoperatively can shed some light on the situation. The less invasive nature of three-dimensional Transesophageal Echocardiography (3D-TEE) can turn it into a practical modality for preoperative investigation of mitral anatomy.

Objectives: The present study aimed to investigate the correlation between the size of mitral annulus attained through 3D-TEE and intraoperative size as well as the valve or ring size finally placed in mitral position.

Method: The study was conducted on 28 patients suffering from MV disease who were candidates for MV surgery. All the patients underwent 3D-TEE. Mitral annulus diameters including anteroposterior and intercommissural diameters were measured delicately by using the Mitral Valve Navigation (MVN) tool. In the midst of surgery, a mitral ring sizer was utilized in order to suggest the proper prosthesis size.

Results: The study results demonstrated that the sizer instrument was strongly associated with the inserted prosthesis size and moderately with echocardiographic annulus diameters. The correlation between the deployed prosthesis size and annulus size obtained by intraoperative sizer and 3D echocardiography was assessed, as well. The results indicated that ring sizer showed a strong positive relationship with the intercommissural echocardiography diameter and a moderate positive relationship with the anteroposterior echocardiography diameter.

Conclusion: The results revealed a good correlation between the echocardiography measurements and intraoperative examination along with the deployed prosthesis size. Thus, 3D-TEE could be considered a practical modality for the preoperative investigation of mitral anatomy.