Abstract 15186: Cleft-Like Indentations in Myxomatous Mitral Valve Disease: 3D Quantitative Analysis of Leaflet Tissue and Annular Dimensions
Background: Myxomatous mitral valve disease (MVD) is a spectrum of lesions, with varying excess tissue and annular size. Cleft-like indentations of posterior leaflet are inconsistently noted and their mechanisms and implications are unknown.
Aims: To investigate 3D-echocardiographic mechanisms of cleft-like indentations (CLI) in MVD and their implications.
Methods: Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 49 patients with MVD and severe regurgitation prior to mitral valve repair surgery. Mitral annular (anteroposterior and intercommissural diameters, circumference, area) and leaflets dimensions (3-dimensional area, volume of prolapse) were measured in end-systole with dedicated quantification software. CLI was defined as a visible defect seen during systole and diastole, extending at least one half of the depth of the adjacent mitral leaflet.
Results: In 17(35%) cases a CLI in the posterior leaflet was noticed by 3D (none identified by 2D) and was confirmed in 88% (15) by surgical visual inspection. Dimension of left ventricle (LV end diastolic diameter 57±6 vs. 57±6 mm; p=0.91) and severity of mitral regurgitation (regurgitant volume 79±29 vs. 89±56; p=0.49) were similar in patients with (n=17) or without (n=32) CLI. The annulus of patients with CLI was smaller, for antero-posterior diameter (42.2±7.1 vs.47.0±7.5 mm, p=0.04), intercommissural diameter (36.5±4.5 vs.41.4±5.9 mm, p=0.005), circumference (133±16 vs.148±19 mm, p=0.009) and area (1289±326 vs.1619±427 mm2, p= 0.008). The volume of prolapse was borderline smaller in patients with CLI (1.9±1.2 vs.4.0±4.3 ml, p=0.06). Importantly, valve tissue quantity was markedly less with than without CLI (leaflets area 1574±409 vs.2019±652 mm2, p=0.01). During valve repair, surgical closure of all cleft-like indentation was required.
Conclusion: Cleft-like indentations of the posterior leaflet are frequent in MVP and are identified purely by 3D transesophageal echocardiography , with high accuracy. CLI are unrelated to annular enlargement or excess prolapse but conversely occur in the context of tissue deficit for annular coverage. Identification of CLI is important as these defects may require closure during valve repair.
- © 2013 by American Heart Association, Inc.