The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Robert C Gorman - One of the best experts on this subject based on the ideXlab platform.
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quantitative analysis of 3 dimensional aortic Annular Geometry implication for aortic root reimplantation
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Liam P. Ryan, Melissa M Levack, Joseph H Gorman, Robert C Gorman, Rita C Milewski, Joseph E. BavariaAbstract:From the Division of Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC; the Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, Pa; and the Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Dec 7, 2012; revisions received March 6, 2013; accepted for publication March 15, 2013; available ahead of print Dec 11, 2013. Address for reprints: Joseph E. Bavaria, MD, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA 19104 (E-mail: Joseph.Bavaria@uphs.upenn.ed). J Thorac Cardiovasc Surg 2014;147:1103-5 0022-5223/$36.00 Copyright 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2013.03.046
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Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis
The Annals of thoracic surgery, 2013Co-Authors: Alison M Pouch, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Chandra M. Sehgal, Paul A. Yushkevich, Joseph H GormanAbstract:Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of Annular Geometry with quantitative imaging techniques. In this work, we present an automated three-dimensional (3D) echocardiographic image analysis method that can be used to statistically assess variability in normal mitral Annular Geometry to support advancement in annuloplasty ring design. Methods Three-dimensional patient-specific models of the mitral annulus were automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. Geometric Annular measurements including Annular circumference, Annular height, septolateral diameter, intercommissural width, and the Annular height to intercommissural width ratio were automatically calculated. A mean 3D Annular contour was computed, and principal component analysis was used to evaluate variability in normal Annular shape. Results The following mean ± standard deviations were obtained from 3D echocardiographic image analysis: Annular circumference, 107.0 ± 14.6 mm; Annular height, 7.6 ± 2.8 mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width, 33.0 ± 5.3 mm; and Annular height to intercommissural width ratio, 22.7% ± 6.9%. Principal component analysis indicated that shape variability was primarily related to overall Annular size, with more subtle variation in the skewness and height of the anterior Annular peak, independent of Annular diameter. Conclusions Patient-specific 3D echocardiographic–based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral Annular Geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal Geometry.
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Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection
The Annals of thoracic surgery, 2013Co-Authors: Arminder S. Jassar, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Albert T. Cheung, Y. Joseph Woo, Michael A. Acker, Joseph H GormanAbstract:Background The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional Annular Geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral Annular shape is markedly distorted in patients with diseased valves. Methods Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six Annular points were defined to generate a 3-dimensional model of the annulus. Regional Annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. Results Annular Geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The Annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with Annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. Conclusions Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, Annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal Annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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Tricuspid Annular Geometry: A Three-Dimensional Transesophageal Echocardiographic Study
Journal of cardiothoracic and vascular anesthesia, 2013Co-Authors: Feroze Mahmood, Joseph H Gorman, Robert C Gorman, Robina Matyal, Han Kim, Bilal Chaudary, Remco Bergman, Jeniffer Gerstle, Kamal R KhabbazAbstract:Objective To demonstrate the clinical feasibility of accurately measuring tricuspid Annular area by 3-dimensional (3D) transesophageal echocardiography (TEE) and to assess the geometric differences based on the presence of tricuspid regurgitation (TR). Also, the shape of the tricuspid annulus was compared with previous descriptions in the literature. Design Prospective. Setting Tertiary care university hospital. Interventions Three-dimensional TEE. Participants Patients undergoing cardiac surgery. Measurements and Main Results Volumetric data sets from 20 patients were acquired by 3D TEE and prospectively analyzed. Comparisons in Annular Geometry were made between groups based on the presence of TR. The QLab (Philips Medical Systems, Andover, MA) software package was used to calculate tricuspid Annular area by both linear elliptical dimensions and planimetry. Further analyses were performed in the 4D Cardio-View (TomTec Corporation GmBH, Munich, Germany) and MATLAB (Natick, MA) software environments to accurately assess Annular shape. It was found that patients with greater TR had an eccentrically dilated annulus with a larger Annular area. Also, the area as measured by the linear ellipse method was overestimated as compared to the planimetry method. Furthermore, the irregular saddle-shaped Geometry of the tricuspid annulus was confirmed through the mathematic model developed by the authors. Conclusions Three-dimensional TEE can be used to measure the tricuspid Annular area in a clinically feasible fashion, with an eccentric dilation seen in patients with TR. The tricuspid annulus shape is complex, with Annular high and low points, and Annular area calculation based on linear measurements significantly overestimates 3D planimetered area.
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dynamic 3 dimensional echocardiographic assessment of mitral Annular Geometry in patients with functional mitral regurgitation
The Annals of Thoracic Surgery, 2013Co-Authors: Kamal R Khabbaz, Ferozeudden Mahmood, Omair Shakil, Haider J Warraich, Joseph H Gorman, Robert C Gorman, Robina Matyal, Peter Panzica, Philip E HessAbstract:Background Mitral valve (MV) Annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV Annular Geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV Annular Geometry associated with FMR. Methods Intraoperative 3D transesophageal echocardiographic data obtained from 34 patients with FMR and 15 controls undergoing cardiac operations were dynamically analyzed for differences in mitral Annular Geometry with TomTec 4D MV Assessment 2.0 software (TomTec Imaging Systems GmbH, Munich, Germany). Results In patients with FMR, the mean mitral Annular area (14.6 cm 2 versus 9.6 cm 2 ), circumference (14.1 cm versus 11.4 cm), anteroposterior (4.0 cm versus 3.0 cm) and anterolateral-posteromedial (4.3 cm versus 3.6 cm) diameters, tenting volume (6.2 mm 3 versus 3.5 mm 3 ) and nonplanarity angle (NPA) (154 degrees ± 15 versus 136 degrees ± 11) were greater at all points during systole compared with controls ( p p Conclusions There are significant differences in dynamic mitral Annular Geometry between patients with FMR and those without. We were able to analyze these changes in a clinically feasible fashion. Ready availability of this information has the potential to aid comprehensive quantification of mitral Annular function and possibly assist in both clinical decision making and annuloplasty ring selection.
Joseph H Gorman - One of the best experts on this subject based on the ideXlab platform.
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quantitative analysis of 3 dimensional aortic Annular Geometry implication for aortic root reimplantation
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Liam P. Ryan, Melissa M Levack, Joseph H Gorman, Robert C Gorman, Rita C Milewski, Joseph E. BavariaAbstract:From the Division of Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC; the Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, Pa; and the Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Dec 7, 2012; revisions received March 6, 2013; accepted for publication March 15, 2013; available ahead of print Dec 11, 2013. Address for reprints: Joseph E. Bavaria, MD, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA 19104 (E-mail: Joseph.Bavaria@uphs.upenn.ed). J Thorac Cardiovasc Surg 2014;147:1103-5 0022-5223/$36.00 Copyright 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2013.03.046
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Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis
The Annals of thoracic surgery, 2013Co-Authors: Alison M Pouch, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Chandra M. Sehgal, Paul A. Yushkevich, Joseph H GormanAbstract:Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of Annular Geometry with quantitative imaging techniques. In this work, we present an automated three-dimensional (3D) echocardiographic image analysis method that can be used to statistically assess variability in normal mitral Annular Geometry to support advancement in annuloplasty ring design. Methods Three-dimensional patient-specific models of the mitral annulus were automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. Geometric Annular measurements including Annular circumference, Annular height, septolateral diameter, intercommissural width, and the Annular height to intercommissural width ratio were automatically calculated. A mean 3D Annular contour was computed, and principal component analysis was used to evaluate variability in normal Annular shape. Results The following mean ± standard deviations were obtained from 3D echocardiographic image analysis: Annular circumference, 107.0 ± 14.6 mm; Annular height, 7.6 ± 2.8 mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width, 33.0 ± 5.3 mm; and Annular height to intercommissural width ratio, 22.7% ± 6.9%. Principal component analysis indicated that shape variability was primarily related to overall Annular size, with more subtle variation in the skewness and height of the anterior Annular peak, independent of Annular diameter. Conclusions Patient-specific 3D echocardiographic–based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral Annular Geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal Geometry.
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Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection
The Annals of thoracic surgery, 2013Co-Authors: Arminder S. Jassar, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Albert T. Cheung, Y. Joseph Woo, Michael A. Acker, Joseph H GormanAbstract:Background The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional Annular Geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral Annular shape is markedly distorted in patients with diseased valves. Methods Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six Annular points were defined to generate a 3-dimensional model of the annulus. Regional Annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. Results Annular Geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The Annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with Annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. Conclusions Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, Annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal Annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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Tricuspid Annular Geometry: A Three-Dimensional Transesophageal Echocardiographic Study
Journal of cardiothoracic and vascular anesthesia, 2013Co-Authors: Feroze Mahmood, Joseph H Gorman, Robert C Gorman, Robina Matyal, Han Kim, Bilal Chaudary, Remco Bergman, Jeniffer Gerstle, Kamal R KhabbazAbstract:Objective To demonstrate the clinical feasibility of accurately measuring tricuspid Annular area by 3-dimensional (3D) transesophageal echocardiography (TEE) and to assess the geometric differences based on the presence of tricuspid regurgitation (TR). Also, the shape of the tricuspid annulus was compared with previous descriptions in the literature. Design Prospective. Setting Tertiary care university hospital. Interventions Three-dimensional TEE. Participants Patients undergoing cardiac surgery. Measurements and Main Results Volumetric data sets from 20 patients were acquired by 3D TEE and prospectively analyzed. Comparisons in Annular Geometry were made between groups based on the presence of TR. The QLab (Philips Medical Systems, Andover, MA) software package was used to calculate tricuspid Annular area by both linear elliptical dimensions and planimetry. Further analyses were performed in the 4D Cardio-View (TomTec Corporation GmBH, Munich, Germany) and MATLAB (Natick, MA) software environments to accurately assess Annular shape. It was found that patients with greater TR had an eccentrically dilated annulus with a larger Annular area. Also, the area as measured by the linear ellipse method was overestimated as compared to the planimetry method. Furthermore, the irregular saddle-shaped Geometry of the tricuspid annulus was confirmed through the mathematic model developed by the authors. Conclusions Three-dimensional TEE can be used to measure the tricuspid Annular area in a clinically feasible fashion, with an eccentric dilation seen in patients with TR. The tricuspid annulus shape is complex, with Annular high and low points, and Annular area calculation based on linear measurements significantly overestimates 3D planimetered area.
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dynamic 3 dimensional echocardiographic assessment of mitral Annular Geometry in patients with functional mitral regurgitation
The Annals of Thoracic Surgery, 2013Co-Authors: Kamal R Khabbaz, Ferozeudden Mahmood, Omair Shakil, Haider J Warraich, Joseph H Gorman, Robert C Gorman, Robina Matyal, Peter Panzica, Philip E HessAbstract:Background Mitral valve (MV) Annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV Annular Geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV Annular Geometry associated with FMR. Methods Intraoperative 3D transesophageal echocardiographic data obtained from 34 patients with FMR and 15 controls undergoing cardiac operations were dynamically analyzed for differences in mitral Annular Geometry with TomTec 4D MV Assessment 2.0 software (TomTec Imaging Systems GmbH, Munich, Germany). Results In patients with FMR, the mean mitral Annular area (14.6 cm 2 versus 9.6 cm 2 ), circumference (14.1 cm versus 11.4 cm), anteroposterior (4.0 cm versus 3.0 cm) and anterolateral-posteromedial (4.3 cm versus 3.6 cm) diameters, tenting volume (6.2 mm 3 versus 3.5 mm 3 ) and nonplanarity angle (NPA) (154 degrees ± 15 versus 136 degrees ± 11) were greater at all points during systole compared with controls ( p p Conclusions There are significant differences in dynamic mitral Annular Geometry between patients with FMR and those without. We were able to analyze these changes in a clinically feasible fashion. Ready availability of this information has the potential to aid comprehensive quantification of mitral Annular function and possibly assist in both clinical decision making and annuloplasty ring selection.
Mathieu Vergnat - One of the best experts on this subject based on the ideXlab platform.
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Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis
The Annals of thoracic surgery, 2013Co-Authors: Alison M Pouch, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Chandra M. Sehgal, Paul A. Yushkevich, Joseph H GormanAbstract:Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of Annular Geometry with quantitative imaging techniques. In this work, we present an automated three-dimensional (3D) echocardiographic image analysis method that can be used to statistically assess variability in normal mitral Annular Geometry to support advancement in annuloplasty ring design. Methods Three-dimensional patient-specific models of the mitral annulus were automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. Geometric Annular measurements including Annular circumference, Annular height, septolateral diameter, intercommissural width, and the Annular height to intercommissural width ratio were automatically calculated. A mean 3D Annular contour was computed, and principal component analysis was used to evaluate variability in normal Annular shape. Results The following mean ± standard deviations were obtained from 3D echocardiographic image analysis: Annular circumference, 107.0 ± 14.6 mm; Annular height, 7.6 ± 2.8 mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width, 33.0 ± 5.3 mm; and Annular height to intercommissural width ratio, 22.7% ± 6.9%. Principal component analysis indicated that shape variability was primarily related to overall Annular size, with more subtle variation in the skewness and height of the anterior Annular peak, independent of Annular diameter. Conclusions Patient-specific 3D echocardiographic–based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral Annular Geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal Geometry.
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Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection
The Annals of thoracic surgery, 2013Co-Authors: Arminder S. Jassar, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Albert T. Cheung, Y. Joseph Woo, Michael A. Acker, Joseph H GormanAbstract:Background The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional Annular Geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral Annular shape is markedly distorted in patients with diseased valves. Methods Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six Annular points were defined to generate a 3-dimensional model of the annulus. Regional Annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. Results Annular Geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The Annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with Annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. Conclusions Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, Annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal Annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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The effect of surgical and transcatheter aortic valve replacement on mitral Annular anatomy.
The Annals of thoracic surgery, 2012Co-Authors: Mathieu Vergnat, Melissa M Levack, Joseph H Gorman, Benjamin M. Jackson, Albert T. Cheung, Joseph E. Bavaria, Howard C. Herrmann, Stuart J. Weiss, Robert C GormanAbstract:Background The effect of aortic valve replacement on three-dimensional mitral Annular Geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral Annular anatomy. Methods Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral Annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global Annular Geometry. Results Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral Annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on Geometry. Patients undergoing open AVR had significant decrease in Annular height, septolateral diameter, mitral valve transverse diameter, and mitral Annular area after valve replacement ( p ≤ 0.006). Similar changes were not noted in the TAVR group. Conclusions Mitral Annular Geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.
Benjamin M. Jackson - One of the best experts on this subject based on the ideXlab platform.
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Statistical Assessment of Normal Mitral Annular Geometry Using Automated Three-Dimensional Echocardiographic Analysis
The Annals of thoracic surgery, 2013Co-Authors: Alison M Pouch, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Chandra M. Sehgal, Paul A. Yushkevich, Joseph H GormanAbstract:Background The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of Annular Geometry with quantitative imaging techniques. In this work, we present an automated three-dimensional (3D) echocardiographic image analysis method that can be used to statistically assess variability in normal mitral Annular Geometry to support advancement in annuloplasty ring design. Methods Three-dimensional patient-specific models of the mitral annulus were automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. Geometric Annular measurements including Annular circumference, Annular height, septolateral diameter, intercommissural width, and the Annular height to intercommissural width ratio were automatically calculated. A mean 3D Annular contour was computed, and principal component analysis was used to evaluate variability in normal Annular shape. Results The following mean ± standard deviations were obtained from 3D echocardiographic image analysis: Annular circumference, 107.0 ± 14.6 mm; Annular height, 7.6 ± 2.8 mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width, 33.0 ± 5.3 mm; and Annular height to intercommissural width ratio, 22.7% ± 6.9%. Principal component analysis indicated that shape variability was primarily related to overall Annular size, with more subtle variation in the skewness and height of the anterior Annular peak, independent of Annular diameter. Conclusions Patient-specific 3D echocardiographic–based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral Annular Geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal Geometry.
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Regional Annular Geometry in Patients With Mitral Regurgitation: Implications for Annuloplasty Ring Selection
The Annals of thoracic surgery, 2013Co-Authors: Arminder S. Jassar, Robert C Gorman, Mathieu Vergnat, Jeremy R. Mcgarvey, Giovanni Ferrari, Benjamin M. Jackson, Albert T. Cheung, Y. Joseph Woo, Michael A. Acker, Joseph H GormanAbstract:Background The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional Annular Geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral Annular shape is markedly distorted in patients with diseased valves. Methods Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six Annular points were defined to generate a 3-dimensional model of the annulus. Regional Annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. Results Annular Geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The Annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with Annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. Conclusions Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, Annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal Annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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The effect of surgical and transcatheter aortic valve replacement on mitral Annular anatomy.
The Annals of thoracic surgery, 2012Co-Authors: Mathieu Vergnat, Melissa M Levack, Joseph H Gorman, Benjamin M. Jackson, Albert T. Cheung, Joseph E. Bavaria, Howard C. Herrmann, Stuart J. Weiss, Robert C GormanAbstract:Background The effect of aortic valve replacement on three-dimensional mitral Annular Geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral Annular anatomy. Methods Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral Annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global Annular Geometry. Results Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral Annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on Geometry. Patients undergoing open AVR had significant decrease in Annular height, septolateral diameter, mitral valve transverse diameter, and mitral Annular area after valve replacement ( p ≤ 0.006). Similar changes were not noted in the TAVR group. Conclusions Mitral Annular Geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.
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Description of regional mitral Annular nonplanarity in healthy human subjects: A novel methodology
The Journal of thoracic and cardiovascular surgery, 2007Co-Authors: Liam P. Ryan, Theodore J Plappert, Robert C Gorman, Benjamin M. Jackson, Yoshiharu Enomoto, Landi M. Parish, Martin G. St. John-sutton, Joseph H GormanAbstract:Objective Finite-element analysis demonstrates that the nonplanar shape of the mitral annulus diminishes mitral leaflet stress. It has therefore been postulated that repair with annuloplasty rings that maintain the nonplanar shape of the annulus could increase repair durability. Although the global nonplanarity of the mitral annulus has been adequately characterized, design of such a ring requires a quantitative description of regional Annular Geometry. By using real-time 3-dimensional echocardiography in conjunction with available image processing software, we developed a methodology for describing regional Annular Geometry and applied it to the characterization of the normal human mitral annulus. Methods Five healthy volunteers underwent mitral valve imaging with real-time 3-dimensional echocardiography. Regional Annular height was calculated at 36 evenly spaced intervals. Results Maximal Annular height/commissural width ratio was found to occur at the midpoint of the anterior annulus in all cases. These values averaged 26% ± 3.1%, whereas those for the midposterior annulus averaged 18% ± 3.0%. The average commissural width was 35.2 ± 6.0 mm. Although substantial spatial heterogeneity was observed, regional Annular height at a given rotational position was highly conserved among subjects when normalized to commissural width. Conclusions These quantitative imaging and analytic techniques demonstrate that the normal human mitral annulus is regionally heterogeneous in its nonplanarity, and they establish a means of describing Annular Geometry at a regional level. With wider application, these techniques may be used both to characterize pathologic Annular Geometry and to optimize the design of mitral valve annuloplasty devices.
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Quantitative description of mitral valve Geometry using real-time three-dimensional echocardiography.
Innovations (Philadelphia Pa.), 2007Co-Authors: Liam P. Ryan, Thomas J Eperjesi, Theodore J Plappert, Robert C Gorman, Benjamin M. Jackson, Martin G. St. John-sutton, Joseph H GormanAbstract:ObjectivesLeaflet and Annular Geometry are important determinants of mitral valve (MV) stress. Repair techniques which optimize valvular Geometry will reduce stress and potentially increase repair ...
Melissa M Levack - One of the best experts on this subject based on the ideXlab platform.
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the value of preoperative 3 dimensional over 2 dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Inez Wijdhden J Hamer, Wobbe Bouma, Eric K Lai, Melissa M Levack, Eric K Shang, Alison M Pouch, Thomas J Eperjesi, Theodore J PlappertAbstract:Abstract 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° (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° (area under the curve, 0.92; 95% confidence interval, 0.84-1.00; P P 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° or larger (especially when combined with basal aneurysm/dyskinesis), chordal-sparing valve replacement should be strongly considered.
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preoperative three dimensional valve analysis predicts recurrent ischemic mitral regurgitation after mitral annuloplasty
The Annals of Thoracic Surgery, 2016Co-Authors: Wobbe Bouma, Eric K Lai, Melissa M Levack, Eric K Shang, Alison M Pouch, Thomas J Eperjesi, Theodore J Plappert, Paul A. Yushkevich, Massimo A MarianiAbstract:Background Valve repair for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings is characterized by high IMR recurrence rates. Patient-specific preoperative imaging-based risk stratification for recurrent IMR would optimize results. We sought to determine if prerepair three-dimensional (3D) echocardiography combined with a novel valve-modeling algorithm would be predictive of IMR recurrence 6 months after repair. Methods Intraoperative transesophageal real-time 3D echocardiography was performed in 50 patients undergoing undersized ring annuloplasty for IMR and in 21 patients with normal mitral valves. A customized image analysis protocol was used to assess 3D Annular Geometry and regional leaflet tethering. IMR recurrence (≥ grade 2) was assessed with two-dimensional transthoracic echocardiography 6 months after repair. Results Preoperative Annular Geometry was similar in all IMR patients, and preoperative leaflet tethering was significantly higher in patients with recurrent IMR (n=13) than in patients in whom IMR did not recur (n=37) (tethering index: 3.91 ± 1.01 vs 2.90 ± 1.17, p = 0.008; tethering angles of A3: 23.5° ± 8.9° vs 14.4° ± 11.4°, p = 0.012; P2: 44.4° ± 8.8° vs 28.2° ± 17.0°, p = 0.002; and P3: 35.2° ± 6.0° vs. 18.6° ± 12.7°, p p Conclusions 3D echocardiography combined with valve modeling is predictive of recurrent IMR. Preoperative regional leaflet tethering of segment P3 is a strong independent predictor of IMR recurrence after undersized ring annuloplasty. In patients with a preoperative P3 tethering angle of 29.9° or larger, chordal-sparing valve replacement rather than valve repair should be strongly considered.
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quantitative analysis of 3 dimensional aortic Annular Geometry implication for aortic root reimplantation
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Liam P. Ryan, Melissa M Levack, Joseph H Gorman, Robert C Gorman, Rita C Milewski, Joseph E. BavariaAbstract:From the Division of Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC; the Gorman Cardiovascular Research Group, University of Pennsylvania School of Medicine, Philadelphia, Pa; and the Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Dec 7, 2012; revisions received March 6, 2013; accepted for publication March 15, 2013; available ahead of print Dec 11, 2013. Address for reprints: Joseph E. Bavaria, MD, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA 19104 (E-mail: Joseph.Bavaria@uphs.upenn.ed). J Thorac Cardiovasc Surg 2014;147:1103-5 0022-5223/$36.00 Copyright 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2013.03.046
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The effect of surgical and transcatheter aortic valve replacement on mitral Annular anatomy.
The Annals of thoracic surgery, 2012Co-Authors: Mathieu Vergnat, Melissa M Levack, Joseph H Gorman, Benjamin M. Jackson, Albert T. Cheung, Joseph E. Bavaria, Howard C. Herrmann, Stuart J. Weiss, Robert C GormanAbstract:Background The effect of aortic valve replacement on three-dimensional mitral Annular Geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral Annular anatomy. Methods Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral Annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global Annular Geometry. Results Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral Annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on Geometry. Patients undergoing open AVR had significant decrease in Annular height, septolateral diameter, mitral valve transverse diameter, and mitral Annular area after valve replacement ( p ≤ 0.006). Similar changes were not noted in the TAVR group. Conclusions Mitral Annular Geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.