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 (BiBTeX, Who 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 (BiBTeX, Who cited this?)

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Dipl.-Ing. Ingmar Voigt

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

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

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



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Department of Computer Science 5 Our Team Voigt, Ingmar Projects Patient-Specific Modeling and Quantification of the Aortic and Mitral Valves from 4D Cardiac CT and TEE Robust Physically-Constrained Modeling of the Mitral Valve and Subvalvular Apparatus Clinical Application and Validation of Personalized Mitral Valve Modeling and Assessment Patient-Specific Model of Left Heart Anatomy, Dynamics and Hemodynamics from 4D TEE Computational Decision Support for Percutaneous Aortic Valve Implantation Towards Patient-Specific Finite-Element Simulation of MitralClip Procedure Learning discriminative distance functions for valve retrieval and improved decision support in valvular heart disease Calibration of laryngeal endoscopic high-speed image sequences by an automated detection of parallel laser line projections Publications Theses Research Publications Free Software Data Courses Curriculum Theses Press Releases Cooperations Open Positions LME Videos Ph.D. Gallery Contact Intranet Impressum Datenschutzerklärung Contact Address Universität Erlangen-Nürnberg Chair of Computer Science 5 (Pattern Recognition) Martensstrasse 3 91058 Erlangen Germany Driving directions Powered by	Dept. of Computer Sc. » Pattern Recognition » Our Team » Voigt, Ingmar » Projects » Clinical Application and Validation of Personalized Mitral Valve Modeling and Assessment 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 (BiBTeX, Who 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 (BiBTeX, Who cited this?)