Two-dimensional echocardiographic identification of prolapse of individual scallops of posterior mitral leaflet

Gondi, Bapineedu; Nanda, Navin C.; Hodsden, James

doi:10.1016/0002-9149(81)90721-9

Cited by 3 publications

(5 citation statements)

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“…For both Q lab and live/real time 3DTTE methods, the medial (close to ventricular septum), middle, or lateral position of the segment/scallop was used to identify posteromedial, middle, and anterolateral segments/scallops, respectively. A3 and P3, A2 and P2, A1 and P1 were assigned to the posteromedial, middle, and anterolateral segments/scallops of the MV, respectively, as previously described 11–13,21–23 . Two of the authors, independently and without knowledge of the surgical findings, reviewed the 3DTTE datasets and identified individual prolapsing segments or scallops.…”

Section: Methodsmentioning

confidence: 99%

“…Historically, this has been accomplished using two‐dimensional (2D) transthoracic and transesophageal echocardiography (TTE and TEE) with adjuvant color Doppler interrogation of the regurgitant orifice. Several studies have demonstrated the usefulness of 2DTTE and 2DTEE in MVP to delineate severity of prolapse and regurgitation, integrity of the chordae and subvalvular apparatus, extent of annular calcification and regurgitation, and left ventricular size and function 10–12 . However, both 2DTTE and 2DTEE suffer from their linear imaging plane and limited spatial axis, which make accurate determination of the exact location and extent of segment/scallop prolapse challenging and cumbersome.…”

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confidence: 99%

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Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

et al. 2006

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

et al. 2006

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“…1 Transthoracic 2D directed M-mode echocardiography has been previously used for detection of individual PML scallop prolapse; however, this method is useful only when AML prolapse is absent. 16 Multiplane 2D TEE has also been used for identifying individual leaflet segments of both AML and PML by manually moving the transducer up and down in the esophagus from the standard four-chamber view. 15 In the four-chamber view, the transverse ultrasound plane is expected to intersect the P2 and A2 and thus detect the prolapse of these segments.…”

Section: Discussionmentioning

confidence: 99%

“…Successful surgical repair of mitral regurgitation due to MVP requires a detailed evaluation of valvular anatomy 1 . Transthoracic 2D directed M‐mode echocardiography has been previously used for detection of individual PML scallop prolapse; however, this method is useful only when AML prolapse is absent 16–18 …”

Section: Discussionmentioning

confidence: 99%

“…1). A1 and P1, A2 and P2, and A3 and P3 were assigned to the anterolateral, middle, and posteromedial sections of the MV, respectively, as previously described 9 , 15–19 . Each of these sections were classified as prolapsing or not and the prolapsed portion of both leaflets was planimetered and the area calculated using an Echo Scan (version 4.1, Tom Tec).…”

Section: Methodsmentioning

confidence: 99%

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Usefulness of Transesophageal Three‐Dimensional Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

Ahmed¹,

Nanda²,

Miller³

et al. 2003

Echocardiography

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We evaluated the potential usefulness of three-dimensional (3D) transesophageal echocardiography (TEE) in assessing individual scallop/segment prolapse in 36 adult patients with mitral valve prolapse (MVP) undergoing surgical correction. Intraoperative 3D TEE correctly identified the location of scallop/segment prolapse in 34 of 36 patients (94%). However, in 6 of these patients 3D TEE images revealed more scallops or segments with prolapse than the surgeon noted intraoperatively. Prolapse of these areas was less prominent and this could possibly explain the lack of correlation with the surgical findings in these patients. In another 2 patients areas of prolapse seen by the surgeon were missed by 3D TEE because some of those scallops/segments could not be well imaged due to image "drop out" and artifacts. Thus, perfect correlation between 3D TEE and surgery was noted in 28 of 36 (78%) patients. Noncoaptation of the MV was also identified in 2 patients. The prolapsed area of posterior (n = 28 observations) and anterior (n = 9 observations) MV leaflets ranged from 1 cm2 to 9 cm2 (mean 3.50 cm2+/- 2.14) and 1.20 cm2 to 5.99 cm2 (mean 3.21 cm2+/- 1.33), respectively. Interobserver and intraobserver agreement for location and area of MVP was excellent (r = 0.97 and r = 0.99, respectively; all P values are <0.0001). In conclusion, 3D TEE is useful in identifying the location of MVP. It may also be potentially useful in assessing the extent of individual scallop/segment prolapse and identifying sites of MV noncoaptation. This information could aid the surgeon in deciding the extent of MV resection.

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Reconsideration of echocardiographic standards for mitral valve prolapse: Lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality

Levine

Stathogiannis

Newell

et al. 1988

Journal of the American College of Cardiology

291

168

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Mitral valve prolapse by current echocardiographic criteria can be diagnosed with surprising frequency in the general population, even when preselected normal subjects are examined. In most of these individuals, however, prolapse is present in the apical four chamber view and absent in roughly perpendicular long-axis views. Previous studies have shown that systolic annular nonplanarity can cause apparent prolapse in the four chamber view without actual leaflet displacement above the most superior points of the anulus, and there is evidence for such nonplanarity in vivo. It is then reasonable to ask whether superior leaflet displacement limited to the four chamber view has any pathologic significance or complications. The purpose of this study, therefore, was to address the following hypothesis: that patients with superior leaflet displacement confined to the four chamber view have no higher frequency of associated echocardiographic abnormalities than do patients without displacement in any view. Such abnormalities, which would provide independent evidence of mitral valve pathology or dysfunction, include leaflet thickening, left atrial enlargement and mitral regurgitation. Leaflet displacement was measured in the parasternal long-axis and apical four chamber views in 312 patients who were studied retrospectively and selected for the absence of forms of heart disease other than mitral valve prolapse. Leaflet thickness and left atrial size were measured and mitral regurgitation was graded. Patients with leaflet displacement limited to the four chamber view were no more likely to have associated abnormalities than were patients without displacement in any view (0 to 2% prevalence, p greater than 0.5). In contrast, patients with leaflet displacement in the long-axis view were significantly more likely to have associated abnormalities (12 to 24%, p less than 0.005), the frequency of which increased with the extent of leaflet displacement in that view (p less than 0.0001). These results suggest that displacement limited to the apical four chamber view is, in general, a normal geometric finding unassociated with echocardiographic evidence of pathologic significance.

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Two-dimensional echocardiographic identification of prolapse of individual scallops of posterior mitral leaflet

Cited by 3 publications

References 0 publications

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

Usefulness of Transesophageal Three‐Dimensional Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

Reconsideration of echocardiographic standards for mitral valve prolapse: Lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality

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