Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: Insights from three-dimensional echocardiography

Abstract

Aims: Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient's functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform® annuloplasty ring using three-dimensional (3D) echocardiography. Methods and results: Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4 ± 0.2 to 0.9 ± 0.3 (P-value < 0.0001), mitral valve tenting volume from 13 ± 1.7 to 3.2 ± 0.3 mL (P-value < 0.001), annulus area from 12.6 ± 1.0 to 3.3 ± 0.2 cm2 (P-value < 0.0001), valve circumference from 13 ± 0.5 to 7.3 ± 0.3 cm (P-value < 0.0001), septolateral distance from 2.1 ± 0.1 to 1.4 ± 0.06 cm (P-value < 0.01) and intercommissural distance from 3.4 ± 0.1 to 2.7 ± 0.03 cm (P-value < 0.03). There was significant decrease in the septolateral distance at the level of A2-P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1 ± 0.3 to 1.3 ± 0.3 (P-value < 0.002). Conclusion: The mitral valve annuloplasty with the Geoform® ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry. © The Author 2008.