Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2014 Jan;97(1):71-7. doi: 10.1016/j.athoracsur.2013.07.096. Epub 2013 Oct 1.
The basis of mitral annuloplasty ring design has progressed from qualitative surgical intuition to experimental and theoretical analysis of annular geometry with quantitative imaging techniques. In this work, we present an automated three-dimensional (3D) echocardiographic image analysis method that can be used to statistically assess variability in normal mitral annular geometry to support advancement in annuloplasty ring design.
Three-dimensional patient-specific models of the mitral annulus were automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. Geometric annular measurements including annular circumference, annular height, septolateral diameter, intercommissural width, and the annular height to intercommissural width ratio were automatically calculated. A mean 3D annular contour was computed, and principal component analysis was used to evaluate variability in normal annular shape.
The following mean ± standard deviations were obtained from 3D echocardiographic image analysis: annular circumference, 107.0 ± 14.6 mm; annular height, 7.6 ± 2.8 mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width, 33.0 ± 5.3 mm; and annular height to intercommissural width ratio, 22.7% ± 6.9%. Principal component analysis indicated that shape variability was primarily related to overall annular size, with more subtle variation in the skewness and height of the anterior annular peak, independent of annular diameter.
Patient-specific 3D echocardiographic-based modeling of the human mitral valve enables statistical analysis of physiologically normal mitral annular geometry. The tool can potentially lead to the development of a new generation of annuloplasty rings that restore the diseased mitral valve annulus back to a truly normal geometry.
二尖瓣瓣环成形术环设计的基础已经从定性的外科直觉发展到使用定量成像技术对瓣环几何形状进行实验和理论分析。在这项工作中，我们提出了一种自动化的三维（3D）超声心动图图像分析方法，可用于统计评估正常二尖瓣瓣环几何形状的可变性，以支持瓣环成形术环设计的发展。
从结构和功能正常的二尖瓣的 3D 超声心动图图像中自动生成患者特异性的二尖瓣瓣环 3D 模型。自动计算几何瓣环测量值，包括瓣环周长、瓣环高度、隔侧-外侧直径、房室结间宽度以及瓣环高度与房室结间宽度的比值。计算出平均 3D 瓣环轮廓，并使用主成分分析评估正常瓣环形状的可变性。
从 3D 超声心动图图像分析中获得以下平均值±标准差：瓣环周长 107.0±14.6mm；瓣环高度 7.6±2.8mm；隔侧-外侧直径 28.5±3.7mm；房室结间宽度 33.0±5.3mm；瓣环高度与房室结间宽度的比值 22.7%±6.9%。主成分分析表明，形状可变性主要与整个瓣环大小有关，瓣环前瓣峰的偏度和高度的变化更为细微，与瓣环直径无关。
基于患者特异性 3D 超声心动图的二尖瓣建模能够对生理性正常二尖瓣瓣环几何形状进行统计分析。该工具可能会导致新一代的瓣环成形术环的发展，将病变的二尖瓣瓣环恢复到真正正常的几何形状。
