Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different.

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Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types Young Joo Suh, MD, Byung-Chul Chang, MD, PhD, Dong Jin Im, MD, Yun Jung Kim, MD, Yoo Jin Hong, MD, Geu-Ru Hong, MD, PhD, Young Jin Kim, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 5, Pages 1082-1090 (November 2015) DOI: 10.1016/j.jtcvs.2015.07.019 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A flow diagram of the study population. MV, Mitral valve; CT, computed tomography. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Correlation of visual grading and quantitative measurement in pannus severity. A, Short-axis computed tomographic image of the mitral valve in a 67-year-old male patient with a 29-mm Duran annuloplasty ring shows the significant pannus. The maximal and minimal annular diameter and area inside the annuloplasty ring measured on computed tomography were 23.2 mm, 16.0 mm, and 3.08 cm2, respectively. The ratio of the area inside the pannus to the inside of the annuloplasty ring was 0.42. B, The box-and-whisker plot shows the difference in area ratio according to pannus severity. The box represents the values from the lower to upper quartile (25th-75th percentile), and the middle line represents the median. A line extends from the minimum to the maximum value. Area ratio refers to the ratio of area inside the pannus to the inside of the annuloplasty. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Box-and-whisker plots of the maximal opening area (A) and the leaflet thickness (B) on computed tomography according to pannus severity. The box represents the values from the lower to upper quartile (25th-75th percentile), and the middle line represents the median. A line extends from the minimum to the maximum value. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Correlation between computed tomographic measurements and transthoracic echocardiographic parameters. A and B, Scatter diagrams showing a negative correlation between the mean pressure gradient (PG) on transthoracic echocardiography and the maximal opening area on computed tomography (A), and a positive correlation between mitral valve area (MVA) on transthoracic echocardiography and the maximal opening area measured on computed tomography (B). C and D, Box-and-whisker plots show differences in (C) the mean pressure gradient and (D) mitral valve area according to pannus severity. The box represents the values from the lower to upper quartile (25th-75th percentile), and the middle line represents the median. A line extends from the minimum to the maximum value. PHT, Pressure half time. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Spaghetti plots of mean diastolic pressure gradient (PG) changes according to the interval from mitral ring annuloplasty. Mean diastolic pressure gradient is gradually elevated in the Duran ring as time passes (0.19 mm Hg/y) with statistical significance but not in the Carpentier-Edwards (CE) ring. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Significant pannus formation causing mitral stenosis in a 52-year-old male patient with the Duran annuloplasty ring. A through C, Computed tomographic images of a patient with a 31-mm Duran ring show leaflet thickening of the mitral valve (A) and severe pannus formation around the annular ring (B and C). The patient underwent mitral ring annuloplasty 16 years before computed tomographic scanning because of subacute infective endocarditis. Mean diastolic pressure gradient on transthoracic echocardiography was elevated (18 mm Hg). D, Severe fibrosis of the mitral valve with a circumferential pannus was seen during reoperative surgery. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Computed tomographic image shows severe pannus causing mitral stenosis in a Duran annuloplasty ring. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1082-1090DOI: (10.1016/j.jtcvs.2015.07.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions