Multiphase Assessment of Mitral Annular Dynamics in Consecutive Patients With Significant Mitral Valve Disease.

OBJECTIVES: The aim of this study was to clarify the dynamics of the mitral annulus throughout the cardiac cycle and its relevance to transcatheter mitral valve replacement (TMVR) sizing and case selection. BACKGROUND: Limited data are available regarding the relevance of mitral annular (MA) and neo-left ventricular outflow tract (LVOT) dynamics in the overall population presenting with significant mitral valve disease. METHODS: Patients attending a combined surgical-transcatheter heart valve clinic for severe symptomatic mitral valve disease were assessed using multiphase computed tomography. The relative influence of MA and neo-LVOT dynamics to TMVR case selection was studied. RESULTS: A total of 476 patients with significant mitral valve disease were evaluated. In 99 consecutive patients with severe mitral regurgitation, a 10-phase assessment showed that the mitral annulus was on average largest in late systole. On comparing maximal MA dimension with late systolic dimension, TMVR size assignment changed in 24.2% of patients. If the average MA perimeter was used to determine sizing, 48.5% were excluded because of MA dimension being too large; in a multiphase assessment of the neo-LVOT, an additional 16.2% were excluded on the basis of neo-LVOT dimension. In an expanded series of 312 consecutive patients, selection protocol influenced anatomical exclusion: a manufacturer-proposed early systolic approach excluded 69.2% of patients, whereas a late systolic approach excluded 82.7% of patients, the vast majority because of large mitral annuli. CONCLUSIONS: Contemporary TMVR can treat only a minority of patients with severe mitral regurgitation, principally because of limitations of large MA dimension.

In vivo longitudinal assessment of bone resorption in a fibular osteotomy model using micro-computed tomography.

Longitudinal in vivo micro-computerized tomography (CT) imaging was used to monitor bone resorption in a rat fibula osteotomy model. Quantitative image post-processing techniques were developed for spatially aligning the longitudinal data sets. Nominal length and bone volume in the proximal and distal segments of the fibula after the osteotomy were measured, and quantitative comparisons of bone loss over a 13-week period post-surgery were made in five individual rats. A significant decrease in nominal length and bone volume of the distal segment was observed 13 weeks post surgery. A significant decrease in bone volume was also observed in the proximal segment. However, no change in nominal length was observed for the proximal segment of the fibula. This study illustrates the power of this non-invasive technology to measure in vivo small changes in bone length and volume using just a small cohort of animals.