Real-time three-dimensional transthoracic echocardiography for predicting mitral annuloplasty ring size

Despite advances in mitral valve repair techniques, including robotic surgeries, few studies are available on predicting mitral annuloplasty ring size using echocardiography. Furthermore, these studies either had limited accuracy or else required the use of three-dimensional transesophageal echocardiography (3D-TEE), an expensive and semi-invasive tool. The study aim was to predict the mitral annuloplasty ring size preoperatively using real-time, three-dimensional transthoracic echocardiography (RT3D-TTE), which is a cheaper, non-invasive technique.

This prospective study included 47 consecutive patients scheduled for elective mitral valve surgery. All participants underwent preoperative RT3D-TTE. The mitral annular transverse diameter during early systole and the maximum height of the A2 scallop were measured in the multiplanar reconstruction mode. The surgeon, who was blinded to the echocardiographic measurements, also measured these two variables intraoperatively. A Pearson correlation coefficient was used to assess the association between the echocardiographic and operative measurements. A linear regression analysis was used to predict the annuloplasty ring size.

A total of 34 patients (72.3%) underwent mitral valve repair. The echocardiographic measurements of the mitral annular transverse diameter were well correlated with the operative measurements (r = 0.64, p < 0.001). A moderate correlation was observed between the echocardiographic and operative measurements of A2 height (r = 0.59, p < 0.001). Linear regression analysis yielded an equation that predicted the annuloplasty ring size (R = 0.828, p < 0.001).

RT3D-TTE was used successfully to predict the mitral annuloplasty ring size. This technique may potentially aid surgical planning, particularly before robotic procedures are performed.