Abstract 18485: Relationship Among Pathologic Changes in Patients with Myxomatous Degeneration: Insights from In Vivo Measurement of Mitral Leaflet Geometry Using 3D TEE Data

Abstract

Background: Although pathologic and imaging studies showed mitral valve leaflet elongation, chordal elongation and rupture (CR), and annular dilatation in patients with myxomatous degeneration (MD), in vivo quantitative analysis of these anatomical changes and their potential relationship has not been reported.

Methods: 3D full volume data were obtained during TEE in 20 healthy subjects and 40 patients with severe mitral regurgitation (MR) due to MD confined to a single scallop in posterior mitral leaflet. A customized software (Omni4D) was used to evaluate mitral valve geometry.

Results: Twenty one patients had typical prolapse without CR, whereas 19 had flail leaflet with CR. Compared to controls, these patients with MD and severe MR showed larger annular area (AA) and total and individual leaflet surface area (LSA) with smaller anterior/posterior LSA. There was no difference in MR severity, AA, total and individual LSA. Positive correlation was observed between LSA and annular area in both controls and patients with MD. Although correlation between posterior LSA and AA was stronger than that between anterior LSA and AA in patients with MD, there was no difference in controls.

Conclusions: Different mechanisms seem to be associated with leaflet elongation in prolapsing and non-prolapsing mitral leaflet and increase in AA and LSA was not different in patients with and those without CR.