Dynamic Annular Modeling of the Unrepaired Complete Atrioventricular Canal Annulus

Hannah H. Nam, Patrick V. Dinh, Andras Lasso, Christian Herz, Jing Huang, Adriana Posada, Ahmed H. Aly, Alison M. Pouch, Saleha Kabir, John Simpson, Andrew C. Glatz, David M. Harrild, Gerald Marx, Gabor Fichtinger, Meryl S. Cohen, Matthew A. Jolley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the 3-dimensional (3D) structure of the atrioventricular canal annulus before repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has been neither quantified nor rigorously compared with a normal mitral valve annulus. Methods: The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared with the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis). Results: The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height-to-valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases (P <.001). Conclusions: The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height-to-valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.

Original languageEnglish
Pages (from-to)654-662
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number2
Publication statusPublished - Feb 2022
Externally publishedYes

Bibliographical note

Funding Information:
The authors wish to thank Emily Harris for assistance with figure illustrations. This work was supported by a Pediatric Heart Network Scholars Award ( National Institutes of Health [NIH] U24HL135691), Big Hearts to Little Hearts, a Children’s Hospital of Philadelphia Cardiac Center Innovation Award, NIH K01 HL141643, NIH1R01HL153166, NIH R01EB021396, and the Canarie Research Software Foundation. Dr Fichtinger is supported as a Canada Research Chair in Computer-Integrated Surgery.

Publisher Copyright:
© 2022 The Society of Thoracic Surgeons


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