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

Abstract

Objective The objective of the study was to evaluate the accuracy of the mitral leaflet separation index (MLSI) in selected patients with mitral stenosis, before and after percutaneous balloon mitral valvuloplasty (PBMV), compared to conventional methods with transthoracic echocardiography [TTE]. Methods A prospective study was conducted in 30 patients, ages 20‐60 years, with severe symptomatic mitral stenosis (MS) who had PBMV in the Cardiology Department, Zagazig University and National Heart Institute. A mean of three to five measurements of MLSI was taken in diastole in the parasternal long‐axis and apical four‐chamber views. The MLSI was re‐measured 24‐48 hours after PBMV. We calculated the correlation of the MLSI, pre and post BMV, with two‐dimensional (2D) MV planimetry and pressure half‐time (PHT) methods to assess MVA. Results There was a positive, highly significant correlation between pre PBMV 2D planimetry and MLSI (r = .665, P‐value < .001) as well as post PBMV 2D planimetry and MLSI (r = .410, P‐value = .025). A positive highly significant correlation was also noted between pre PBMV PHT and MLSI (r = .678, P‐value <.001) and between post PBMV PHT and MLSI (r = .706, P‐value <.001). Conclusion Mitral leaflet separation index is an easy and reliable measurement for the assessment of mitral stenosis before and after PBMV.

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

“…A few studies showed good predictivity of MLSI for MVA even in the presence of AFib, MR and in post-PTMC state. 8,15,16 In the current study's subgroup analysis, the relation was significant between MLSI and MVA in the presence of AFib. It is much quicker, feasible and reliable to take multiple readings of the distance, MLSI, rather than multiple planimetric areas and multiple readings of PHT which is usually significantly affected by the varying haemodynamics of AFib.…”