Mitral valve anatomy and function

Muraru, Denisa; Cattarina, Maria; Boccalini, Francesca; Lin, Carlo Dal; Peluso, Diletta; Zoppellaro, Giacomo; Bellù, Roberto; Sarais, Cristiano; Xhyheri, Borejda; Iliceto, Sabino; Badano, Luigi P.

doi:10.2459/jcm.0b013e328356a577

Cited by 20 publications

(6 citation statements)

References 38 publications

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“…The currently used 2D-Wilkins score had basically depended on assessment of four parameters (MV leaflets’ mobility, thickness and calcification, and subvalvular involvement), and although its limitations that have been noted for a long time therefore many modifications were developed [17–19]; Wilkins scores ≤ 8/16 persisted as an independent predictor of acute success after BMV in a recent study conducted by Meneguz-Moreno et al on a very long-term follow-up after percutaneous BMV [20]. The 3DE enables a comprehensive anatomic characterization of leaflet, commissural, and chordal involvement from any unconventional plane [15]. A novel 3D scoring system for MV was introduced by Anwar et al, which basically depended on scoring of both MV leaflets and chordal affection [6].…”

Section: Discussionmentioning

confidence: 99%

“…Real-time 3D-TTE was undertaken for all patients within 24–48 h before and immediately after BMV using Philips IE 33 X-matrix echo machine and X5-1 matrix-array transducer (2007 Koninklijke Philips Electronics N.V.) with continuous ECG monitoring. Image acquisition was done according to Lang et al [14] for assessment of MV and estimating the MVA [15]. Pre-procedural commissural affection and post-procedural splitting were assessed, where fusion of both commissures (anterolateral and posteromedial) indicated no splitting, width of splitting < 0.5 cm indicating partial splitting, and width of splitting > 0.5 cm indicating complete splitting.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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BackgroundResults of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique.ResultsThe 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = − 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04).ConclusionThe 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results.Electronic supplementary materialThe online version of this article (10.1186/s43044-019-0019-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…4–6 The recently updated valvular regurgitation guidelines recommend comprehensive imaging with routine incorporation of 3DE when assessing etiologies of MR. 7 As such, the increasing use of three-dimensional (3D) transesophageal echocardiography (TEE) has resulted in better understanding of the mechanisms of MR (including cleft MV) before surgical or percutaneous intervention. When patients with significant MR due to unrecognized cleft MV are referred for surgical intervention, the likelihood of its diagnosis in a nonbeating, flaccid heart at the time of surgery is lower.…”

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confidence: 99%

Diagnosis of Isolated Cleft Mitral Valve Using Three-Dimensional Echocardiography

Narang

Addetia

Weinert

et al. 2018

Journal of the American Society of Echocardiography

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Background: The prevalence of isolated cleft mitral valve (MV; no concomitant congenital heart disease or degenerative MV disease) with significant mitral regurgitation (MR) diagnosed using two-dimensional echocardiography (2DE) has been reported to be very low. Three-dimensional echocardiography (3DE) has enabled a more comprehensive visualization of the MV and detailed understanding of the mechanisms of MR and can potentially reveal isolated cleft MV that is not recognized with 2DE. The aim of this study was to determine, using 3DE, the prevalence, location, and associated MV annular and left ventricular characteristics of isolated cleft MV, in the absence of associated congenital heart disease, in patients with significant MR. Methods: A total of 1,092 patients with unexplained moderate or greater MR on two-dimensional transthoracic echocardiography who were referred for three-dimensional transesophageal echocardiography between 2005 and 2017 (n = 626) were retrospectively studied. Left ventricular dimensions and function were determined, and quantitative MR assessment and three-dimensional analysis of the MV annulus was performed. Results: Twenty-one patients (prevalence 3.3%) were diagnosed with isolated cleft MV using three-dimensional transesophageal echocardiography but not 2DE. The majority of these patients (n = 16) were noted to have anterior cleft MVs, with most located in the mid-A1 (n = 10) or mid-A3 (n = 5) scallops. Posterior clefts were less common (n = 5) and occurred at the site of the natural scallop indentations (three between P1 and P2 and two between P2 and P3). Among patients with either anterior or posterior MV cleft, there were no differences in left ventricular ejection fraction or three-dimensional MV geometry (annular distance, height, circumference, and area). There was a trend toward worse MR severity in patients with anterior cleft MV. Conclusions: In patients with otherwise unexplained significant MR referred for transesophageal echocardiography, 3DE uncovered a considerably higher prevalence of isolated cleft MV than previously reported by 2DE, with the majority located in the anterior MV. Although the annular geometry was similar between patients with anterior and posterior cleft MVs, a trend toward more severe MR in anterior clefts may reflect underlying abnormalities in the embryologic development of the anterior MV leaflet. Evaluation of MV pathology is improved by 3DE, which should be used routinely in the setting significant MR. (J Am Soc Echocardiogr 2018;31:1161-7.)

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“…However, due to its tomographic nature, 2D echocardiography, both TTE and transoesophageal (TEE), has limited capability in defining the complex 3D anatomic characteristics of the cleft such as position, size, and morphology. The added value of 3D echocardiography in assessing mitral valve morphology and function has been extensively documented in acquired mitral valve disease 6 . 3D echocardiography allows the display of the non-planar geometry of the valve leaflets and annulus, as well as the complex subvalvular apparatus and its spatial relationships with the surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy

Miglioranza¹,

Muraru²,

Mihaila³

et al. 2014

Arquivos Brasileiros De Cardiologia

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Mitral valve anatomy and function

Cited by 20 publications

References 38 publications

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

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

Diagnosis of Isolated Cleft Mitral Valve Using Three-Dimensional Echocardiography

Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy

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