Abstract 19873: Relationship Between Jet Direction and Mitral Valve Tethering in Patients With Ischemic Mitral Regurgitation: Real-Time Three Dimensonal Transesophageal Echocardiography Study
Background: Mitral regurgitant (MR) jet direction with ischemic etiology is usually central or posterior. We hypothesized that severely restricted posterior mitral leaflet (PML) is a cause of relative prolapse of AML with posterioly directed MR in patients with ischemic MR. Relationship between leaflet configurations and direction of ischemic MR was investigated by real-time three dimensional transesophageal echocardiography (3DTEE).
Methods: In 33 patients with IMR were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior planes (medial, middle, and lateral) were generated for imaging the mitral valve in midsystole (Figure). In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aa; posterior, Pa) were measured (Figure). MR grade was evaluated by vena contract (VC) width.
Results: 1) In patients with IMR, MR jet direction was central in 20 and posterior in 13 with the absence of anterior jet. 2) Patients with posterior MR jet had greater MR VC width and tenting area than those with central MR jet. 3) Compared to patients with central MR jet, those with posterior MR jet had smaller AML tethering (Aa: medial: 30±5 vs. 25±4 degrees, p<0.05; middle: 28±5 vs. 23±4 degrees, p<0.05, lateral; 25±3 vs. 22±3 degrees, p<0.05). withgreater PML tethering angle (Pa: medial: 52±7 vs. 57±7 degrees, p<0.05; middle:50±5 vs. 55±7 degrees, p<0.05, lateral; 49±5 vs. 50±7 degrees, p<0.05). 4) 3 of the 13 patients with posterior MR jet had eccentric wall jet with small local prolapse of AML.
Conclusion: Severely tethered PML may causeless tethering and small prolapse of AML with posterioly directed MR jet. 3DTEE is a valuabletool for differentiating the geometry of the mitral apparatus of ischemic mitral regurgitation.
- © 2010 by American Heart Association, Inc.