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Dipl.-Ing. Ingmar Voigt

Alumnus of the Pattern Recognition Lab of the Friedrich-Alexander-Universität Erlangen-Nürnberg

Personalized healthcare with robust patient-specific models of anatomy and function
Project Description

Automated Quantitative 3-D Echocardiography of The Surgical Mitral Valve Anatomy in Functional Mitral Regurgitation to Guide Mitral Valve Repair

Background: The contributions of mitral annular (MA) and leaflet (ML) remodeling to functional mitral regurgitation (FMR) is a key factor in the consideration of mitral valve repair. Also, selection of the ring size and type is based on quantification of MA and ML remodeling. We tested the feasibility of a novel automated, 3-D modeling algorithm using real-time volumetric TEE (3-D TEE) to quantify MA and ML remodeling in FMR.

Methods: The MV was automatically modeled from clinical 3-D TEE data in 15 normals and 27 patients (12 with normal annulus size- Group 1,15 with dilated annulus- Group 2) with > moderate FMR. The following parameters were automatically quantified using a previously described algorithm (IEEE Trans Medical Img 2010;29: 1636-50): Antero-posterior (AP) and anterolateral-posteromedial (AL-PM) annuluar diameters, intercommissural distance (ICD), trigone length (TL),anterior leaflet height (ALH), total annular circumference (AC), and anterior and posterior annular circumference (AAC and PAC). The dynamic change in AP diameter was computed as the difference in early systole (ES) vs. early diastole.

Results: The only significant difference between normals and Group 1 FMR was in the reduction in the change AP annular diameter in ES (Table 1). The latter indicates reduction in the dynamic annular remodeling in ES so that there is reduced accentuation of the saddle shape with consequent reduction in leaflet coaptation. In Group 2 FMR, the ALH was markedly increased (= significant ML remodeling) in addition to a dilated, adynamic annulus. The choice of ring size and type can be made based on the automated measurements of the TL, AC, AAC, APC, ALH. Figure shows representative example.

Conclusion: Automated 3-D quantitative surgical anatomy in FMR 1) shows that an adynamic annulus is an early basis for MR, followed by annular dilatation and anterior leaflet lengthening, and 2) that these mechanistic insights and the quantitative characterization of the pathologic anatomy can aid surgical decision-making.

Project Description

Superior Reproducibility of Automated 3-D Surgical Anatomy of Normal and Abnormal Mitral Valve when Compared to  a Manual Approach

Background: Manual identification and contouring of landmarks to obtain qunatitative 3-D parameters of the MV anatomy are tedious and have poor reproducibility. We tested whether an automated method to quantify the surgical MV anatomy was superior to the manual method.

Methods: Real-time TEE data from 12 normals and 15 patients with functional MR (FMR) was used. QLab (Philips, Andover, MA, manual method) and a novel automated MV software (Siemens, Princeton NJ, automated method (IEEE Trans Medical Img 2010;29: 1636-50) were used to measure: anteroposterior and anterolateral-posteromedial (AP, ALPM) diameters, inter-commissural distance (ICD), anterior and posterior leaflet heights (ALH, PLH), and annular circumference (AC). We compared normal Vs. FMR, and assessed the inter- and intra-observer variability.

Results: (mean SD, mm): As shown in Table 1, all the parameters were significantly increased in FMR compared to Normal. Only ICD is measured the same way by both methods and it was comparable in Normal (mean diff. 1.6±0.8, p=0.1) and FMR (mean diff. 1.7±0.8, p=0.1). Reproducibility data is shown in Table 2 and it was superior in the automated method for all paraameters. Moreover, the range of variation in the measures was smaller in automated Vs. manual method: Normal 2 to 5% Vs. 2 to 14%, and FMR 2 to 8% Vs. 3 to 12%. The average time to complete quantification was 1- 2 minutes by automated Vs. 10-15 minutes by the manual method.

Conclusion:Automated 3-D quantification of the surgical anatomy of normal and abnormal MV is feasible, time-efficient and more reproducible

Publications

Calleja, Anna; Stiver, Kevin; Thavendiranathan, Paaladinesh; Liu, Shizhen; Ionasec, Razvan; Voigt, Ingmar; Houle, Helene; De Michelis, Nathalie; Ryan, Tomas; Vannan, Mani
Automated Quantitative 3-D Echocardiography of The Surgical Mitral Valve Anatomy in Functional Mitral Regurgitation to Guide Mitral Valve Repair In: American Society of Echocardiography (Eds.)
Proceedings of the 22nd ASE Annual Scientific Sessions (22nd ASE Annual Scientific Sessions Montreal 11-14.06.2011) USA : American Society of Echocardiography 2011, pp. n/a (BiBTeXWho cited this?

Stiver, Kevin; Calleja, Anna; Ionasec, Razvan; Voigt, Ingmar; Thavendiranathan, Paaladinesh; Liu, Shizhen; Houle, Helene; De Michelis, Nathalie; Ryan, Tomas; Vannan, Mani
Superior Reproducibility of Automated 3-D Surgical Anatomy of Normal and Abnormal Mitral Valve when Compared to a Manual Approach In: American Society of Echocardiography (Eds.)
Proceedings of the 22nd ASE Annual Scientific Sessions (22nd ASE Annual Scientific Sessions Montreal 11-14.06.2011) USA : American Society of Echocardiography 2011, pp. n/a (BiBTeXWho cited this?