Routine methods of analyzing mitral annulus
The European Society of Cardiology (ESC) recommendations suggest A-P
diameter of the mitral annulus to be the gold standard measurement for
guiding surgical interventions and do not take into account the annulus
area and circumference (11). However, one of the first indications for
3D echocardiography was MV assessment (12,13) and the development of
probes and software helped in understanding the exact complex anatomy of
the annulus and the leaflets, label the scallops and commissures,
localize the pathology and provide corresponding “surgical” 3D en face
views of the MV (13,14). This advanced quantitative assessment of the
annular geometry helped the surgeons to improve the reparative surgery
results (15). Still, all these measurements were provided from TOE
examinations and, through several previous clinical studies, it has been
confirmed that these data correlate well with the ones measured with
cardiac computed tomography (3, 4, 16), cardiac magnetic resonance
(17,18) and even the direct valve measurements during the operations
(19). Nevertheless, it is practically difficult to follow up every
patient with TOE, as this is a semi-invasive method that mostly requires
sedation which may alter the hemodynamics of the patient resulting in
inaccurate assessment during mitral regurgitation evaluation. TTE is the
gold standard method for routine evaluation of patients, as TTE probes
achieve high quality 2D and color Doppler images that make the
assessment relatively easy (11). Recent developments in TTE probes
increased the spatial and temporal resolution and provided more detailed
evaluation of the MV. Thus, 3D TTE became more reproducible and
accurate. Our study demonstrated a strong correlation between TTE and
TOE in mitral annular assessment, however further investigation needs to
be done to establish TTE for routine MV assessment.