Abstract 16040: Variable Morphology of P2 Flail in Degenerative MR: A 3D-Echocardiographic Study
Objective: Degenerative mitral regurgitation is common and frequently addressed using mitral valve repair. Using intraoperative real-time three-dimensional echocardiography (rt-3DE) and specially developed software, we describe a high resolution, quantitative geometric model of human mitral valves with flail mid-posterior (P2) leaflet segments.
Methods: Intraoperative transesophageal echocardiography (TEE) using a Philips ie33 ultrasound module and x7-2t rt-3DE probe was performed prior to surgical repair of degenerative mitral regurgitation in 15 patients with P2 flail. Images were imported to an offline workstation for analysis with Tomtec Echo-View. Fully 3D models of the annuli and leaflets under loaded conditions (midsystole) were created using custom Matlab algorithms. Anatomic regurgitant orifice (ARO) was traced by planimetry in the 3D rendered model of the mitral valve.
Results: 3D models demonstrated significant heterogeneity in leaflet shape and regurgitant orifice (figure). Three distinct morphologies (groups) were identified: (1) posterior leaflet (PL) prolapsing and convex into the left atrium, (2) PL leading edge flail into the LA creating a relatively flat PL, and (3) PL leading edge curled under itself. ARO was largest in group 1 (0.71 ± 0.27 cm2, n = 9), smaller in group 2 (0.40 ± 0.22 cm2, n = 4), and smallest in group 3 (0.20 ± 0.0 cm2, n = 2). These differences were significant by ANOVA (p = 0.034); group 1 and 3 were significantly different with respect to ARO by unpaired t-test (p = 0.039).
Conclusions:Rt-3DE by TEE generates high resolution 3D models of valvular pathology. Variable morphology of flail P2 leaflets in degenerative MR was identified using this novel method; the categorization of morphology was supported by statistical differences in ARO quantification. Differing mechanical and anatomic pathology in the P2 segment in patients with degenerative MR may dictate divergent approaches to operative planning and repair techniques.
- © 2010 by American Heart Association, Inc.