Accurate Measurement of Mitral Annular Dimensions by Echocardiography: Importance of Correctly Aligned Imaging Planes and Anatomic Landmarks

J Am Soc Echocardiogr. 2009 May;22(5):458-63. doi: 10.1016/j.echo.2009.02.008. Epub 2009 Apr 9.


Background: Mitral annular (MA) dimensions obtained by traditional two-dimensional echocardiography are poorly standardized and do not adhere to anatomic principles. Correct anatomic imaging planes of the anterior-posterior (AP) and commissure-commissure (CC) axes of the mitral annulus were compared with the traditional method and correlated with cardiac computed tomography (CT).

Methods: Seventeen subjects underwent traditional and correct anatomic imaging planes echocardiography and cardiac CT. The traditional method was obtained in the parasternal long-axis and apical 4-chamber views. Correct anatomic imaging planes were obtained in the apical long-axis view. The traditional and correct anatomic images planes methods were correlated with cardiac CT.

Results: The traditional method of MA measurement correlated poorly with cardiac CT (AP axis: r = 0.13; CC axis: r = 0.02). The correct anatomic imaging planes method of MA measurement correlated very well with cardiac CT (AP axis: r = 0.96; CC axis: r = 0.91) (P < .05).

Conclusions: The correct anatomic imaging planes method provides accurate measurement of the AP and CC axes of the mitral annulus by adhering to geometric and anatomic principles.

Publication types

  • Evaluation Study

MeSH terms

  • Echocardiography, Three-Dimensional / methods*
  • Female
  • Humans
  • Image Enhancement / methods*
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging*
  • Reproducibility of Results
  • Sensitivity and Specificity