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Cardiac Magnetic Resonance Analysis of the Coaptation Length of the Mitral Valve After Valve Repair

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Cardiac Magnetic Resonance Analysis of the Coaptation Length of the Mitral Valve After Valve Repair

Carlos M A Brandao, PhD; Ahmad A Abdouni, MD; Carlos Rochitte, PhD; Ariane B. Pacheco, MD, Elinthon T Veronese, MD; Antonio S S A Lopes, PhD; Pablo M A Pomerantzeff, PhD; Fabio B Jatene, PhD

Heart Institute, University of Sao Paulo Medical School



Objective: The coaptation length of the mitral valve after repair is an important prognostic factor in the evaluation of surgical outcome. Its measure has been performed at a single point in the mitral valve, usually A2/P2, and may not reflect the coaptation throughout the valve. Our goal is to analyze the coaptation length in different segments of the mitral valve in patients undergoing mitral valve repair by quadrangular resection without ring annuloplasty using the cardiovascular magnetic resonance (CMR).

Methods:  Twenty-nine patients with degenerative mitral insufficiency underwent mitral valve repair with the “Double Teflon” technique between July 2014 and August 2016. All patients were prospectively followed up and underwent CMR 30 days, 6 months and 1 year after surgery, using a specific protocol for the evaluation of the mitral valve. From the image in the short axis of the mitral valve, we obtained 6 to 8 images in the long axis in 3 chamber view, with alignment of the scallops A1-P1, A2-P2 and A3-P3, approximately parallel to the left ventricle outflow tract. With these images, it was possible to visualize the coaptation of the mitral valve in each of these segments.

Results: After mitral valve repair, we observed a mean coaptation length of 6.2 ± 2.1 mm, and it ranged from 2.7 to 11.2 mm. After 6 months, there was a significant reduction (p=0.011) of this coaptation, which was 5.4 ± 2.21 mm (2.4 to 11.0 mm) and then remained stable until 1 year follow-up (p=1,0), when the mean coaptation length was 5.4 ± 2.18 mm (2.6 to 11.3 mm). There was no recurrence of mitral regurgitation in the study period.

Conclusion: CMR is a good method to obtain the coaptation length throughout the mitral valve after valve repair.

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