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Updated: May 27, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Mitral annular nonplanarity: correlation between annular height/commissural width ratio and the nonplanarity angle
Haider J Warraich1, Bilal Chaudary, Andrew Maslow
1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. hwarraic@bidmc.harvard.edu
Objective:
To compare two methods of mitral annular nonplanarity: the mathematically calculated annular height-to-commissural width ratio (AHCWR) and the echocardiographically derived nonplanarity angle.
Design:
Prospective.
Setting:
Tertiary care university hospital.
Interventions:
Three-dimensional transesophageal echocardiography.
Participants:
Patients undergoing mitral valve surgery.
Measurements And Main Results:
Using 3-dimensional transesophageal echocardiography, volumetric datasets were acquired from 22 patients undergoing mitral valve surgery. The intraoperative nonplanarity angle was calculated with Mitral Valve Assessment software (Tomtec GmbH, Munich, Germany). Furthermore, the datasets acquired during 3-dimensional transesophageal echocardiography were exported to Matlab software (MathWorks, Natick, MA), which was used to calculate the AHCWR. The nonplanarity angle was seen to correlate favorably with the AHCWR (r = 0.70).
Conclusions:
A favorable correlation was found between the nonplanarity angle and the AHCWR. This suggests that the nonplanarity angle can be used to assess mitral annular nonplanarity in a clinically feasible fashion.
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