Abstract 14229: Real-time Three-dimensional Transesophageal Echocardiography Identifies the Association Between a Small Posterior Leaflet and a Pseudoprolapse of Anterior Leaflet in Eccentric Functional Mitral Regurgitation
Introduction: Functional mitral regurgitation (FMR) is sometimes associated with an eccentric jet due to a small pseudoprolapse (PP) of the anterior leaflet. We assessed that real-time three-dimensional transesophageal echocardiography (RT3DTEE) can accurately describe its true nature.
Methods: We analyzed 60 patients with at least moderate FMR and RT3DTEE data available. We identified a group of 30 patients with an eccentric posterior directed jet and a control group of 30 patients with a central jet. RT3DTEE data was analyzed off-line to obtain the measurements of mitral annulus and leaflets. The PP height and width was measured in patients with eccentric FMR cropping the volume in the appropriate planes as shown in the figure. Clinical and two-dimensional echocardiographic data were also collected and compared between both groups.
Results: All patients with eccentric FMR had a PP of the middle scallop of the anterior leaflet which maximum height was 4 ± 0.5 mm and its width was 10 ± 2 mm. No PP was found in patients with central FMR. Both groups were well balanced for age, gender, ejection fraction and the presence of ischaemic cardiomyopathy. There was a higher proportion of patients with severe FMR in those with an eccentric jet and also atrial fibrillation was more frequently seen in these patients. The posterior leaflet was significantly smaller in the eccentric FMR group. Annular dimensions were similar in both groups and no differences were found in the insertion angle of leaflets or tenting height.
Conclusions: A PP of the anterior leaflet and a small posterior leaflet are associated with the development of eccentric FMR and RT3DTEE can accurately identify these characteristics.
- © 2013 by American Heart Association, Inc.