Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery

Handa, Kazuma; Kawamura, Masashi; Yoshioka, Daisuke; Saito, Shunsuke; Kawamura, Takuji; Kawamura, Ai; Misumi, Yusuke; Taira, Masaki; Shimamura, Kazuo; Komukai, Sho; Kitamura, Tetsuhisa; Miyagawa, Shigeru

doi:https://doi.org/10.1161/JAHA.124.035826

Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery

Handa, Kazuma; Kawamura, Masashi; Yoshioka, Daisuke et al.

Journal of the American Heart Association, 2024, 13(16)

Number of Access:1,691（2025-07-22 20:35 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/98459

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Title	Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery
Creator	CreatorName Handa, Kazuma
	NRID 1000070583011 1000070583011 researchmap permalink mk_mk mk_mk CreatorName Kawamura, Masashi
	NRID 1000040645959 1000040645959 researchmap permalink d-yoshioka d-yoshioka Scopus Author ID 7003892845 7003892845 CreatorName Yoshioka, Daisuke
	NRID 1000030600126 1000030600126 ORCID 0000-0002-0829-2891 0000-0002-0829-2891 researchmap permalink shunsaito shunsaito Scopus Author ID 57205524320 57205524320 CreatorName Saito, Shunsuke
	NRID 1000060839398 1000060839398 researchmap permalink takuji-kawamura takuji-kawamura Scopus Author ID 55331768500 55331768500 ORCID 0000-0003-2985-0036 0000-0003-2985-0036 CreatorName Kawamura, Takuji
	NRID 1000010838923 1000010838923 researchmap permalink a-kawamura a-kawamura Scopus Author ID 56414159900 56414159900 CreatorName Kawamura, Ai
	NRID 1000020631477 1000020631477 researchmap permalink yusukemisumi yusukemisumi CreatorName Misumi, Yusuke
	NRID 1000090624651 1000090624651 Scopus Author ID 57188551084 57188551084 CreatorName Taira, Masaki
	NRID 1000010507205 1000010507205 researchmap permalink kazuo-shimamura kazuo-shimamura Scopus Author ID 35969640700 35969640700 CreatorName Shimamura, Kazuo
	NRID 1000070794543 1000070794543 ORCID 0000-0002-4329-2520 0000-0002-4329-2520 researchmap permalink sho.komukai sho.komukai Scopus Author ID 57200127087 57200127087 CreatorName Komukai, Sho
	NRID 1000030639810 1000030639810 ORCID 0000-0003-0107-0580 0000-0003-0107-0580 researchmap permalink Kitamura_T Kitamura_T Scopus Author ID 22234282700 22234282700 CreatorName Kitamura, Tetsuhisa
	NRID 1000070544237 1000070544237 ORCID 0000-0003-0015-6569 0000-0003-0015-6569 researchmap permalink s-miyagawa3154 s-miyagawa3154 Scopus Author ID 55560624700 55560624700 CreatorName Miyagawa, Shigeru
Subject	3-dimensional transesophageal echocardiography
	aortic root rotation position
	atrioventricular conduction disorder
	mitral valve surgery
Description	Handa K., Kawamura M., Yoshioka D., et al. Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery. Journal of the American Heart Association 13, e035826 (2024); https://doi.org/10.1161/JAHA.124.035826.
Abstract	BACKGROUND: Variations in the aortomitral positional anatomy, including aortic root rotation appear to be related to variations in the location of the conduction system, including the bundle of His. However, little is known about their clinical significance. METHODS AND RESULTS: This study included 147 patients with normal ECGs who underwent mitral valve surgery. The aortomi-tral anatomy was classified using preoperative 3-dimensional transesophageal echocardiography, and postoperative conduction disorders, including atrioventricular block and bundle branch block, were analyzed. Variations classified as aortomitral appearance were designated as having a center appearance (85.7%, n=126/147) or lateral appearance (14.3%, n=21/147) on the basis of whether the aortic root was located at the center or was shifted to the left fibrous trigone side. Subsequently, those with a center appearance, aortic root rotation was classified as having a center rotation (83.3% [n=105/126]), in which the com-missure of the left and noncoronary aortic leaflet was located at the center, lateral rotation (14.3% [n=18/126]), rotated to the left trigone side, or medial rotation (2.4% [n=3/126]), rotated to the right. The incidence of 3-month persistent new-onset conduction disorder was higher in the lateral appearance than the center appearance group (21.1% versus 5.0%; P=0.031) and higher in the lateral rotation than in the center or medial rotation groups (29.4% versus 1.0% versus 0.0%, respectively; P<0.001). CONCLUSIONS: Aortomitral variations can be classified using 3-dimensional transesophageal echocardiography. Lateral appearance and lateral rotation are risk factors for conduction disorders in mitral valve surgery.
Publisher	American Heart Association Inc.
Source Title	Journal of the American Heart Association
Volume (Issue)	13(16)
Date of Issued	2024-08-20
Language	English
Handle URL	https://hdl.handle.net/11094/98459
eISSN	20479980
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1161/JAHA.124.035826
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCTERMS.bibliographicCitation	Journal of the American Heart Association. 2024, 13(16)
DC.title	Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery
DC.creator	Handa, Kazuma
	Kawamura, Masashi
	Yoshioka, Daisuke
	Saito, Shunsuke
	Kawamura, Takuji
	Kawamura, Ai
	Misumi, Yusuke
	Taira, Masaki
	Shimamura, Kazuo
	Komukai, Sho
	Kitamura, Tetsuhisa
	Miyagawa, Shigeru
DC.publisher	American Heart Association Inc.
DC.language' scheme='DCTERMS.RFC1766	English
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2024-08-20
DC.identifier	https://doi.org/10.1161/JAHA.124.035826
DC.subject	3-dimensional transesophageal echocardiography
	aortic root rotation position
	atrioventricular conduction disorder
	mitral valve surgery
DC.description	Handa K., Kawamura M., Yoshioka D., et al. Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery. Journal of the American Heart Association 13, e035826 (2024); https://doi.org/10.1161/JAHA.124.035826.
DCTERMS.abstract	BACKGROUND: Variations in the aortomitral positional anatomy, including aortic root rotation appear to be related to variations in the location of the conduction system, including the bundle of His. However, little is known about their clinical significance. METHODS AND RESULTS: This study included 147 patients with normal ECGs who underwent mitral valve surgery. The aortomi-tral anatomy was classified using preoperative 3-dimensional transesophageal echocardiography, and postoperative conduction disorders, including atrioventricular block and bundle branch block, were analyzed. Variations classified as aortomitral appearance were designated as having a center appearance (85.7%, n=126/147) or lateral appearance (14.3%, n=21/147) on the basis of whether the aortic root was located at the center or was shifted to the left fibrous trigone side. Subsequently, those with a center appearance, aortic root rotation was classified as having a center rotation (83.3% [n=105/126]), in which the com-missure of the left and noncoronary aortic leaflet was located at the center, lateral rotation (14.3% [n=18/126]), rotated to the left trigone side, or medial rotation (2.4% [n=3/126]), rotated to the right. The incidence of 3-month persistent new-onset conduction disorder was higher in the lateral appearance than the center appearance group (21.1% versus 5.0%; P=0.031) and higher in the lateral rotation than in the center or medial rotation groups (29.4% versus 1.0% versus 0.0%, respectively; P<0.001). CONCLUSIONS: Aortomitral variations can be classified using 3-dimensional transesophageal echocardiography. Lateral appearance and lateral rotation are risk factors for conduction disorders in mitral valve surgery.
DC.rights	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
DC.format	98459
citation_title	Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery
citation_author	Handa, Kazuma
	Kawamura, Masashi
	Yoshioka, Daisuke
	Saito, Shunsuke
	Kawamura, Takuji
	Kawamura, Ai
	Misumi, Yusuke
	Taira, Masaki
	Shimamura, Kazuo
	Komukai, Sho
	Kitamura, Tetsuhisa
	Miyagawa, Shigeru
citation_publisher	American Heart Association Inc.
citation_language	English
citation_date	2024-08-20
citation_journal_title	Journal of the American Heart Association
citation_volume	13
citation_issue	16
citation_doi	https://doi.org/10.1161/JAHA.124.035826
citation_public_url	https://hdl.handle.net/11094/98459

Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery

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