Visualization and Quantification of the Unrepaired Complete Atrioventricular Canal Valve Using Open-Source Software

Overview

Journal J Am Soc Echocardiogr

Specialty Radiology

Date 2022 May 10

PMID 35537615

Authors

Hannah H Nam

Christian Herz

Andras Lasso

Alana Cianciulli

Maura Flynn

Jing Huang

Zi Wang

Beatriz Paniagua

Jared Vicory

Saleha Kabir

John Simpson

David Harrild

Gerald Marx

Meryl S Cohen

Andrew C Glatz

Matthew A Jolley

Affiliations

Soon will be listed here.

Abstract

Background: Repair of complete atrioventricular canal (CAVC) is often complicated by residual left atrioventricular valve regurgitation. The structure of the mitral and tricuspid valves in biventricular hearts has previously been shown to be associated with valve dysfunction. However, the three-dimensional (3D) structure of the entire unrepaired CAVC valve has not been quantified. Understanding the 3D structure of the CAVC may inform optimized repair.

Methods: Novel open-source work flows were created in SlicerHeart for the modeling and quantification of CAVC valves on the basis of 3D echocardiographic images. These methods were applied to model the annulus, leaflets, and papillary muscle (PM) structure of 35 patients (29 with trisomy 21) with CAVC using transthoracic 3D echocardiography. The mean leaflet and annular shapes were calculated and visualized using shape analysis. Metrics of the complete native CAVC valve structure were compared with those of normal mitral valves using the Mann-Whitney U test. Associations between CAVC structure and atrioventricular valve regurgitation were analyzed.

Results: CAVC leaflet metrics varied throughout systole. Compared with normal mitral valves, the left CAVC PMs were more acutely angled in relation to the annular plane (P < .001). In addition, the anterolateral PM was laterally and inferiorly rotated in CAVC, while the posteromedial PM was more superiorly and laterally rotated, relative to normal mitral valves (P < .001). Lower native CAVC atrioventricular valve annular height and annular height-to-valve width ratio before repair were both associated with moderate or greater left atrioventricular valve regurgitation after repair (P < .01).

Conclusions: It is feasible to model and quantify 3D CAVC structure using 3D echocardiographic images. The results demonstrate significant variation in CAVC structure across the cohort and differences in annular, leaflet, and PM structure compared with the mitral valve. These tools may be used in future studies to catalyze future research intended to identify structural associations of valve dysfunction and to optimize repair in this vulnerable and complex population.

Citing Articles

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Wu W, Daneker M, Herz C, Dewey H, Weiss J, Pouch A ArXiv. 2025; .

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Effect of Parametric Variation of Chordae Tendineae Structure on Simulated Atrioventricular Valve Closure.

Mangine N, Laurence D, Sabin P, Wu W, Herz C, Zelonis C ArXiv. 2024; .

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FEBio FINESSE: An Open-Source Finite Element Simulation Approach to Estimate In Vivo Heart Valve Strains Using Shape Enforcement.

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PMID: 39499365 PMC: 11831577. DOI: 10.1007/s10439-024-03637-3.

The effects of leaflet material properties on the simulated function of regurgitant mitral valves.

Wu W, Ching S, Sabin P, Laurence D, Maas S, Lasso A J Mech Behav Biomed Mater. 2023; 142:105858.

PMID: 37099920 PMC: 10199327. DOI: 10.1016/j.jmbbm.2023.105858.

The Effects of leaflet material properties on the simulated function of regurgitant mitral valves.

Wu W, Ching S, Sabin P, Laurence D, Maas S, Lasso A ArXiv. 2023; .

PMID: 36798457 PMC: 9934730.

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