Abstract 13295: Influence of Chronic Tethering of the Mitral Valve on Mitral leaflet Size and Coaptation in Patients with Functional Mitral Regurgitation: A Three-dimensional Transesophageal Echocardiography Study
Background: Functional mitral regurgitation (FMR) occurs as the Results of tethering of mitral leaflet, mitral Annular (MA) dilatation and insufficient adaptive dilatation of the leaflet area (LA).
Objectives: The aim of our study was to examine whether chronic tethering of the mitral leaflets affects mitral valvular size and coaptation in patients with (≥ moderate) FMR using 3-dimensional transesophageal echocardiography (3DTEE).
Methods: 3DTEE was performed in 18 patients with significant FMR and 29 controls. With a novel software system, total LA (TLA) at the onset of mitral leaflet closure and MA area (MAA) at mid-systole were measured. The coaptation length (CL) was measured at the medial, middle and lateral sites on the cross-sectional planes selected from the 3D data set.
Results: TLA and MAA corrected by body surface area were significantly larger in patients with FMR than those in the controls (TLA: 9.2 ± 2.1 cm2/m2 vs. 5.8 ± 1.7 cm2/m2, p < 0.0001, MAA: 6.9 ± 1.8 cm2/m2 vs. 4.4 ± 0.7 cm2/m2, p < 0.0001). In contrast, the CL in patients with FMR significantly decreased in all 3sites compared with controls (medial: 3.3 ± 0.4 mm vs. 4.5 ± 0.4 mm, p < 0.0001, middle: 3.5 ± 0.5 mm vs. 5.2 ± 0.9 mm p < 0.0001, lateral: 3.6 ± 0.4 mm vs. 4.1 ± 0.6 mm, p < 0.05) (Figure).
Conclusions: Despite increased mitral leaflet size to compensate for the increased mitral annular size and tethering, coaptation decreased significantly in patients with FMR. Insufficient adaptive increase in TLA, or “mitral leflet remodeling”, may be related to the development of FMR.
- © 2010 by American Heart Association, Inc.