Cosgrove-Edwards mitral ring dynamics measured with transesophageal three-dimensional echocardiography

Background. Flexible rings have been introduced for improved mitral valve annuloplasty. These rings allow systolic-diastolic variation of both the shape and the area of the valve orifice, mimicking the normal dynamics of the mitral valve ring. In humans, information on the functional behavior of the Cosgrove-Edwards ring during the cardiac cycle is limited at present. Methods. We used transesophageal three-dimensional echocardiography to analyze mitral valve rings in 19 consecutive patients who underwent annuloplasty because of severe (grade III to IV) mitral regurgitation. Fifteen patients received a Cosgrove-Edwards ring and 4 received a Carpentier ring. The acquisition for three-dimensional reconstruction was performed using the transesophageal rotational technique, immediately after operation. Horizontal cross-sections through the mitral valve ring were selected from the data sets for measurement of the dimensions and surface area of the mitral valve orifice at end-systole and end-diastole. Measurements of the flexible Cosgrove-Edwards ring and the rigid Carpentier ring were compared. Results. Adequate images for measurements were obtained in 17 of 19 patients. The end-systolic orifice area of the Cosgrove-Edwards ring was 4.21 ± 1.50 cm2 (mean ± standard deviation) and the end-diastolic area was 4.81 ± 1.56 cm2 (p < 0.0001). No significant change in the orifice area of the Carpentier ring was observed. Conclusions. Three-dimensional transesophageal echocardiography allows the functional assessment in vivo of mitral valve annuloplasty rings. The Cosgrove-Edwards ring maintains its flexibility early after implantation and demonstrates significant systolic-diastolic changes in the orifice area during the cardiac cycle.

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