Imaging of the orifice of the left ventricular outflow tract: technique and initial results

Article type: Research Article

Authors: Komoda, Takeshi^a | Hetzer, Roland^{a; *} | Oellinger, Johann^b | Siniawski, Henryk^a | Hofmeister, Joseph^a | Hübler, Michael^a | Felix, Roland^b | Uyama, Chikao^c | Maeta, Hajime^d

Affiliations: [a] Department of Cardiovascular Surgery, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany | [b] Department of Radiology, University Hospital Rudolf Virchow, Augustenburger Platz 1, 13353 Berlin, Germany | [c] Department of Investigative Radiology, National Cardiovascular Center Research Institute, Fujishiodai 5-7-1, Suita, 565 Osaka, Japan | [d] The First Department of Surgery, Kagawa Medical School, Ikenobe 1750-1, Miki-cho, Kita-gun, 761-07 Kagawa, Japan

Correspondence: [*] Corresponding author: Professor Roland Hetzer, M.D., Department of Cardiovascular Surgery, German Heart Institute Berlin, Augustengurger Platz 1, 13353 Berlin, Germany. Tel.: +49 30 45 93 2000; Fax: +49 30 45 93 2100.

Abstract: The mechanism of left ventricular outflow tract (LVOT) obstruction in the patient after mitral valve replacement or repair was examined with the aid of 2D echocardiography. For the interpretation of the spatial relationship between the aortic root and mitral annulus, however, the 2D display is sometimes inadequate since it may not simultaneously capture these structures in each center. We developed a method to clarify this relationship in 3D based on magnetic resonance images. We defined the office of the left ventricular outflow tract (LVOT orifice), consisting of, in turn, a muscular region, i.e., edge of the interventricular septum, and an annular region, i.e., the annulus of the anterior mitral leaflet. In this paper we present image data obtained from one of eight normal subjects examined and compare this with data of one of two patients who preoperatively suffered degenerative mitral regurgitation and subsequently underwent chordal-preserving mitral valve replacement, in which anterior chordae were reattached to the anterior annulus. In the normal subject, the mitral annulus exhibited a flexible change in shape during the systole, maintaining sufficient LVOT orifice size. In the patient, the prosthetic valve exhibited translational motion during systole, resulting in dynamic LVOT obstruction. This phenomenon was also observed in one other case. Furthermore, the lateral view of the LVOT orifice revealed a projection of the prosthetic valve into the LVOT, causing mechanical LVOT obstruction. The finding that translational motion of the prosthetic valve with an inflexible mitral annulus results in dynamic LVOT obstruction may support the hypothesis that annular rigidity causes dynamic LVOT obstruction after mitral valve repair with a rigid prosthetic ring.

Keywords: Left ventricular outflow tract (LVOT), mitral annulus, mitral valve replacement, dynamic LVOT obstruction

DOI: 10.3233/THC-1997-5304

Journal: Technology and Health Care, vol. 5, no. 3, pp. 207-217, 1997