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Mitral anulus motion. Relation to pulmonary venous and transmitral flows in normal subjects and in patients with
G Keren1, E H Sonnenblick, T H LeJemtel
1Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
Insights
Mitral anulus motion significantly impacts heart filling. In dilated cardiomyopathy, this motion is reduced or absent, affecting pulmonary venous flow and cardiac function.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- The mitral anulus (MA) is crucial for cardiac function, influencing left atrial and ventricular filling.
- Understanding MA dynamics is key to diagnosing and managing heart conditions.
Purpose of the Study:
- To investigate the relationship between mitral anulus motion and cardiac filling dynamics.
- To compare MA motion and pulmonary venous flow in normal subjects versus patients with dilated cardiomyopathy.
Main Methods:
- Doppler echocardiography was used to study 12 normal subjects and 28 patients with dilated cardiomyopathy.
- Analysis focused on mitral anulus motion, pulmonary venous inflow, and transmitral filling patterns.
Main Results:
- Normal MA motion exhibits two phases of pulmonary venous inflow, correlating with ventricular systole and early diastole.
- Rapid MA recoil during early diastole aids atrial-to-ventricular blood displacement.
- In dilated cardiomyopathy, MA motion is markedly reduced or absent, altering flow dynamics.
Conclusions:
- Mitral anulus motion is intrinsically linked to normal cardiac filling.
- Altered MA motion in dilated cardiomyopathy significantly disrupts normal physiological flow patterns.
Abstract:
The dynamics between mitral anulus motion, and, thus, motion of the base of the heart, and filling of the left atrium and ventricle were studied by Doppler echocardiography in 12 normal subjects and 28 patients with dilated cardiomyopathy. The normal motion of the mitral anulus is associated with two phases of inflow from the pulmonary veins. The first phase (J) of pulmonary venous inflow occurs during ventricular systole, concomitant with the descent of the mitral anulus toward the ventricular apex, the extent of which is 12.8 +/- 1.4 mm. The end of the descent of the anulus occurs at the cessation of aortic ejection. About 100 msec later, a rapid recoil of the mitral anulus toward the atrium coincides with the onset of transmitral filling. This rapid recoil contributes to the displacement of blood from the atria into the ventricles in early diastole. The second phase (K) of pulmonary venous flow begins in early diastole, with its peak occurring about 50 msec after the peak of transmitral flow. During atrial contraction, the mitral anulus moves slightly (2.4 +/- 0.7 mm) toward the atrium and then returns toward its initial position within 120 msec. This motion coincides with the A wave of transmitral flow. In patients with dilated cardiomyopathy, pulmonary venous flow and mitral anulus motion are markedly altered in comparison with normal subjects. In all patients, motion of the mitral anulus is either reduced or absent.(ABSTRACT TRUNCATED AT 250 WORDS)