Dynamic Computed Tomographic Assessment of the Mitral Annulus in Patients With and Without Mitral Prolapse

Abstract Objectives To obtain 3D CT measurements of mitral annulus throughout cardiac cycle using prototype mitral modeling software, assess interobserver agreement, and compare among patients with mitral prolapse (MP) and control group. Background Pre-procedural imaging is critical for planning of transcatheter mitral valve (MV) replacement. However, there is limited data regarding reliable CT-based measurements to accurately characterize the dynamic geometry of the mitral annulus in patients with MV disease. Methods Patients with MP and control subjects without any MV disease who underwent ECG-gated cardiac CT were retrospectively identified. Multiphasic CT data was loaded into a prototype mitral modeling software. Multiple anatomical parameters in 3D space were recorded throughout the cardiac cycle (0-95%): annular circumference, planar-surface-area (PSA), anterior-posterior (A-P) distance, and anterolateral-posteromedial (AL-PM) distance. Comparisons were made among the two groups, with p Results A total of 100 subjects were included: 50 with MP and 50 control. Annular dimensions were significantly higher in the MP group than control group, with circumference (144±11 vs. 117±8mm), PSA (1533±247 vs. 1005±142mm2), A-P distance (38±4 vs. 32±2mm), and AL-PM distance (47±4 vs. 39±3mm) (all p Conclusion A significant variation in the mitral annular measures between different cardiac phases and two groups was observed with excellent interobserver agreement.