Mitral annulus morphometry in degenerative mitral regurgitation phenotypes

Abstract

Objectives Degenerative mitral regurgitation (DMR) is classified into different phenotypes based on the extent of leaflet degeneration. Our aim is to demonstrate that phenotype complexity predicts the extent of structural abnormalities of mitral annulus (MA). Methods and results Seventy‐five patients with DMR and severe valve regurgitation and 23 patients with normal mitral valve were studied using 3D transesophageal echocardiography. Classification of DMR was done by allocating each 3D echocardiography result under five categories: fibroelastic deficiency (FED), FED+, forme fruste, Barlow’s disease Mitral annular disjunction (BD MAD)– or BD MAD+. MA was reconstructed in early systole and in end systole. We tested for a trend toward enlargement and flattening of MA in end systole and for a difference in MA dynamics from early systole to end systole with a worsening of DMR phenotype, in the whole spectrum of subjects ranging from controls to BD MAD+. A significant trend was observed toward larger anteroposterior diameter, intercommissural diameter, annulus circumference, and annulus area (P < .001). A reduction was found in annulus height to commissural width ratio (P = .003): This indicates a progressive MA flattening. Prolapse height and prolapse volume tended to be larger (P < .001). Conclusion Based on the extent of leaflet degeneration, DMR is classified into different phenotypes. As the disease progresses, a related increase in MA size is found, with rounder annular shape, loss of saddle shape, and increase in height and volume of leaflet prolapse. The most pronounced alterations are found in BD MAD+.

Definition, prevalence, and clinical significance of mitral annular disjunction in different patient cohorts: A systematic review

“…Our search yielded 80 potentially relevant studies. After screening of titles, abstracts, and full manuscripts of potentially relevant studies, a total of twelve studies 1,8,[11][12][13][14][15][16][17][18][19][20] met the inclusion criteria and were included in the review (Figure 4). 1.…”

“…In total, nine studies investigated MAD in MVP and/or Barlow's disease. 1,[11][12][13][15][16][17]19,20 The most commonly reported dimension of MAD was ≥5 mm. From these studies the pooled rate of MVP / Barlow's disease and MAD was 30.1%.…”

“…From these studies the pooled rate of MVP / Barlow's disease and MAD was 30.1%. 12,13,16,19,20 Eriksson et al reported that MAD was more common in patients with more severe myxomatous MV disease compared to those with mild/moderate disease. 1 Essayagh et al found MAD to be more common in patients with posterior MVP and bileaflet MVP.…”

3D mitral annulus echocardiography assessment in patients affected by degenerative mitral regurgitation who underwent mitral valve repair with flexible band

“…The degenerative mitral valve disease (DMVD) is the most frequent cause of mitral regurgitation in Europe with a prevalence of the 2%–3% 2–4 . The pathophysiological mechanisms and morphological spectrum of DMVD are wide and complex; it mainly includes two categories, namely the fibroelastic deficiency (FED) and Barlow disease (BD), and a variety of patterns in‐between 5–7 …”

“…[2][3][4] The pathophysiological mechanisms and morphological spectrum of DMVD are wide and complex; it mainly includes two categories, namely the fibroelastic deficiency (FED) and Barlow disease (BD), and a variety of patterns in-between. [5][6][7] Mitral valve repair (MVR) represents the treatment of choice for the surgical correction of DMVD and aims to restore leaflet coaptation without compromising the mitral apparatus mobility. 8 Since the mitral annulus is almost always affected in DMVD, the mitral annuloplasty with the positioning of a prosthetic ring is the most widely performed and reliable procedure; this intervention is able to reestablish annular shape and size and to allow long-term durability of repair .…”