Mitral Annular Remodeling with Varying Degrees and Mechanisms of Chronic Mitral Regurgitation

Annulus tension of the prolapsed mitral valve corrected by edge-to-edge repair

“…We already found that actual AT in MV bileaflet prolapse is lower than normal myocardial force and has a potential of annular dilatation even without left ventricle remodeling (He and Bhattacharya, 2008). That is why the MV annulus is dilatated in MV prolapse while the left ventricle size remains normal and supported by the clinical study (Mihalatos et al, 2007;David et al, 2003). ETER reduced or eliminated leakage, but not annular dilatation as AT decreased more or less in mono-leaflet prolapse.…”

“…ETER alters MV geometry and thus AT according to suture pattern, which affects leaflet stress He et al, 2009) and suture tension (He et al, 1997;Mihalatos et al, 2007;David et al, 2003). If the tension in the suture is high, it may pull the leaflets towards the center.…”

Echocardiographic quantification of mitral valvular response to myocardial revascularization

“…[26] Studies have demonstrated that as mitral annulus enlarges, it loses its ability to change its position and shape. [4,27] Several echocardiographic indices are utilized in measuring the degree of mitral regurgitation. Tenting height, tenting area, and tenting volume provide information about overall tethering effect.…”

“…[1] Reduced leaflet closing forces due to left ventricular (LV) dysfunction, [2] increased systolic mitral leaflet tethering due to papillary muscle displacement, [3] and annular dilatation [4] have been implicated in the development of IMR. It has been shown that mitral annulus dilates, flattens, and assumes a more spherical shape, resulting in reduced leaflet coaptation and mitral regurgitation.…”

An Alternative Isovelocity Surface Model for Quantitation of Effective Regurgitant Orifice Area in Mitral Regurgitation With an Elongated Orifice

“…Our mean diameter was 3.3 cm. Mihalatos et al (13) reported that the MV orifice becomes circular and its diameter increases progressively with MR severity. They found mean end-systolic and end-diastolic diameters of 1.95 cm/m 2 and 1.86 cm/m 2 , respectively, in 19 severe MR cases.…”