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 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.

3D patient-specific models of the mitral annulus are automatically generated from 3D echocardiographic images acquired from subjects with normal mitral valve structure and function. A mean 3D annular contour is computed, and principal component analysis is used to evaluate variability in normal annular shape.

It is possible that a wider application of this analysis could provide information for a new generation of annuloplasty ring designs. All current designs are manufactured in a range of sizes with all sizes maintaining the same shape. With further study it may become apparent that to completely restore normal valve geometry, the next generation of saddle-shaped annuloplasty devices would best be created with subtle variations in shape as ring size increases.

- A. M. Pouch, M. Vergnat, J. R. McGarvey, G. Ferrari, B. M. Jackson, C. M. Sehgal, P. A. Yushkevich, R. C. Gorman, and J. Gorman 3rd, “Statistical assessment of normal mitral annular geometry using automated three-dimensional echocardiographic analysis.,” Ann Thorac Surg, vol. 97, iss. 1, pp. 71-77, 2014.

[Bibtex]`@ARTICLE{Pouch2014ATS, author = {Pouch, Alison M. and Vergnat, Mathieu and McGarvey, Jeremy R. and Ferrari, Giovanni and Jackson, Benjamin M. and Sehgal, Chandra M. and Yushkevich, Paul A. and Gorman, Robert C. and Gorman, 3rd, Joseph H}, title = {{S}tatistical assessment of normal mitral annular geometry using automated three-dimensional echocardiographic analysis.}, journal = {{A}nn {T}horac {S}urg}, year = {2014}, volume = {97}, pages = {71--77}, number = {1}, month = {Jan}, abstract = {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.}, doi = {10.1016/j.athoracsur.2013.07.096}, institution = {{G}orman {C}ardiovascular {R}esearch {G}roup, {U}niversity of {P}ennsylvania, {P}hiladelphia, {P}ennsylvania; {D}epartment of {S}urgery, {U}niversity of {P}ennsylvania, {P}hiladelphia, {P}ennsylvania. {E}lectronic address: gormanj@uphs.upenn.edu.}, language = {eng}, medline-pst = {ppublish}, owner = {alison}, pii = {S0003-4975(13)01709-8}, pmid = {24090576}, timestamp = {2014.02.27}, url = {http://dx.doi.org/10.1016/j.athoracsur.2013.07.096} }`