The Relation of Mitral Valve Morphology to Severe Mitral Regurgitation Complicated With Mitral Valve Prolapse

Sonoda, Makoto; Takenaka, Katsu; Uno, Kansei; Ebihara, Aya; Nagai, Ryozo

doi:10.2303/jecho.6.1

Cited by 3 publications

(2 citation statements)

References 42 publications

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“…Our study found mild valve leaflet thickening and extensive subvalvular chordae in more than half of RMCT patients, representing almost all pathological types (Figure 1 ). Echocardiography identified that mild valve leaflet thickening accounted for 58.7%, and extensive subvalvular chordae for 53.8% of cases, which may explain why leaflet thickness and length were closely related to the occurrence of RMCT or severe MR [ 17 ]. Echo enhancement and abnormal echo were also very common in all pathological types.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

Luo

Wang

et al. 2011

J Cardiothorac Surg

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BackgroundThe accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae (RMCT) has not yet been investigated with a large study.MethodsClinical, hemodynamic, surgical, and pathological findings were reviewed for 242 patients with a preoperative diagnosis of RMCT that required mitral valvular surgery. Subjects were consecutive in-patients at Fuwai Hospital in 2002-2008. Patients were evaluated by thoracic echocardiography (TTE) and transesophageal echocardiography (TEE). RMCT cases were classified by location as anterior or posterior, and classified by degree as partial or complete RMCT, according to surgical findings. RMCT cases were also classified by pathology into four groups: myxomatous degeneration, chronic rheumatic valvulitis (CRV), infective endocarditis and others.ResultsEchocardiography showed that most patients had a flail mitral valve, moderate to severe mitral regurgitation, a dilated heart chamber, mild to moderate pulmonary artery hypertension and good heart function. The diagnostic accuracy for RMCT was 96.7% for TTE and 100% for TEE compared with surgical findings. Preliminary experiments demonstrated that the sensitivity and specificity of diagnosing anterior, posterior and partial RMCT were high, but the sensitivity of diagnosing complete RMCT was low. Surgical procedures for RMCT depended on the location of ruptured chordae tendineae, with no relationship between surgical procedure and complete or partial RMCT. The echocardiographic characteristics of RMCT included valvular thickening, extended subvalvular chordae, echo enhancement, abnormal echo or vegetation, combined with aortic valve damage in the four groups classified by pathology. The incidence of extended subvalvular chordae in the myxomatous group was higher than that in the other groups, and valve thickening in combination with AV damage in the CRV group was higher than that in the other groups. Infective endocarditis patients were younger than those in the other groups. Furthermore, compared other groups, the CRV group had a larger left atrium, higher aortic velocity, and a higher pulmonary arterial systolic pressure.ConclusionsEchocardiography is a reliable method for diagnosing RMCT and is useful for classification. Echocardiography can be used to guide surgical procedures and for preliminary determination of RMCT pathological types.

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Section: Discussionmentioning

confidence: 99%

The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

Luo

Wang

et al. 2011

J Cardiothorac Surg

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“…Characteristics of outward displacements of medial and lateral PMs were different between inferior and anterior MI. This study demonstrated utility of echocardiography to evaluate mitral valve pathophysiology [31]. However, antero-posterior, medio-lateral, and baso-apical components of PM displacements were not investigated.…”

Section: Limitationsmentioning

confidence: 88%

Different Mechanisms of Ischemic Mitral Regurgitation in Patients With Inferior and Anterior Myocardial Infarction

Zhang

Uemura

et al. 2008

J Echocardiogr

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Background. Basic mechanism of ischemic mitral regurgitation (MR) is displacement of papillary muscles (PMs) due to left ventricular (LV) remodeling. Variability in LV remodeling can potentially cause heterogeneous PM displacements.The aim of this study is to compare the mitral valve complex geometry in patients with ischemic MR due to inferior and anterior myocardial infarction (MI).Methods. In 33 patients with prior inferior MI, 61 with anterior MI, and 22 controls, LV volume, mitral annular area, PM tethering distance, and MR were quantified by echocardiography. Conclusions. Although patients with ischemic MR due to inferior MI have asymmetrically predominant medial PM displacement, those with ischemic MR due to anterior MI have symmetric bilateral PM displacements. (J Echocardiogr 2008; 3: 74-83)

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Different Influences of Left Ventricular Remodeling on Anterior and Posterior Mitral Leaflet Tethering

Nakai

Kaku

Takeuchi

et al. 2012

Circ J

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Background: Different influences of left ventricular (LV) remodeling on anterior and posterior mitral leaflet (AML and PML) tethering in ischemic mitral regurgitation (MR) has not been fully investigated. We hypothesized that progressive outward displacement of papillary muscles, including posterior vector, may cause greater tethering to PML compared to AML. Methods and Results:In 79 patients with LV ejection fraction <50% and 20 controls, LV sphericity, AML and PML tethering angles, apical and posterior displacement of coaptation, mitral annular area, and severity of MR (vena contracta width) were measured using 3-D echocardiography. To examine different influences of LV remodeling on AML and PML tethering, interaction between AML/PML and LV sphericity was tested using multiple regression analysis. Both AML and PML tethering significantly increased with increased LV sphericity (r=0.59 and 0.65, P<0.001). Multiple regression yielded a significant interaction term between AML vs. LV sphericity and PML vs. LV sphericity (t=3.69, P<0.001), indicating greater influence from LV remodeling on PML compared to that for the AML. Multivariate analysis demonstrated independent contributions to MR severity from PML tethering primarily along with posterior and apical displacement of coaptation. Conclusions

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The Relation of Mitral Valve Morphology to Severe Mitral Regurgitation Complicated With Mitral Valve Prolapse

Cited by 3 publications

References 42 publications

The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

Different Mechanisms of Ischemic Mitral Regurgitation in Patients With Inferior and Anterior Myocardial Infarction

Different Influences of Left Ventricular Remodeling on Anterior and Posterior Mitral Leaflet Tethering

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