Three-Dimensional Echocardiographic Measurements of Distance Between Papillary Muscles and Mitral Annulus: Assessment With Three-Dimensional Quantification Software System

Objective. Although preservation of mitral annulus and papillary muscle alignment is important in mitral valve surgery, it has been difficult to measure the precise distance between mitral annulus and papillary muscles in clinical setting. We sought to quantify the distances between mitral annulus and papillary muscles by using the 3D quantitation software system, REAL VIEW®.Methods. We examined 10 patients with functional mitral regurgitation due to dilated cardiomyopathy and 10 normal controls by real-time 3D echocardiography. Using REAL VIEW®, the 3D images of mitral annulus and the tips of papillary muscles were reconstructed in end-systole. Mitral annular area and circumference, mitral leaflet tenting length and volume, and the 6 distances between the tips of papillary muscles and corresponding points of the mitral annulus were measured three-dimensionally.Results. Patients with functional mitral regurgitation due to dilated cardiomyopathy had larger annular size, apparent leaflet tenting and longer papillary muscle to mitral annular distances compared with the controls.Conclusions. We demonstrated 3D echocardiographic measurements of papillary muscle to mitral annular distances with REAL VIEW®, in clinical setting. This technique should be applicable to understandable demonstration and quantitative evaluation of subvalvular geometry in various mitral valve diseases.