Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty

Abstract

AimTo evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV).MethodsNinety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views.ResultsMVA increased from 0.95 ± 0.28 to 2.21 ± 0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ± 0.23 to 2.21 ± 0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively.ConclusionThe MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.

Additive value of 3D-echo in prediction of immediate outcome after percutaneous balloon mitral valvuloplasty

“…Nevertheless, safety and success of BMV techniques are mainly dependent on the selection of suitable patients. Patient ages, functional class, mitral valve (MV) morphology, pre-procedural MV area (MVA), and the size of the balloon used; all are considered as predictors of procedural outcome [3, 4]. Current scores that target patient selection before BMV—particularly the two-dimensional (2D) Wilkins score—may have many limitations including inability to assess commissural involvement or differentiate nodular fibrosis from calcification, ignoring the distribution of pathologic abnormalities and contribution of each variable and underestimating subvalvular disease [5].…”

Mitral leaflet separation index correlation with mitral stenosis severity, a reliable easy 2-d echocardiography technique

“…Compared to the traditional methods, MLSI is easier, less timeconsuming and requires less expertise. 7 Studies have been carried out to determine the validity of MLSI for the estimation of MVA and has shown reliable sensitivity and specificity, but data is generally scarce and the studies done have been performed on a small number of patients [8][9][10] . The current study was planned to find out the effectiveness of MLSI in determining MV stenosis severity among comparatively larger group of patients coming to the tertiary care hospital.…”

“…5 To overcome this limitation, a few studies in small groups of patients have been done on a simple novel technique of calculating the mitral leaflet separation index (MLSI) to determine MS severity. [6][7][8][9][10] Severe MS can be predicted with 90-92% sensitivity and 82-92% specificity when the mitral leaflet separation is <7.8mm. [6][7][8][9][10] The current study was planned to evaluate the accuracy of MLSI in the determination of MS severity in patients with rheumatic MS, and to assess the reliability of MLSI in different concomitant conditions, like atrial fibrillation (AFib) and mitral regurgitation (MR).…”

Mitral leaflet separation index for mitral valve assessment during balloon mitral valvuloplasty

“…3D TTE or TEE recently emerged as a valuable tool but is not widely available in developing countries 2,8 . The search for a quick test with high accuracy has been an advantage for MSLI 9–12 …”