Abstract 16564: Sagittal and Coronal Motion of the Papillary Muscle Heads Associated With Functional Mitral Regurgitation: A Three-Dimensional Transesophageal Echocardiographic Study
Background: Functional mitral regurgitation (FMR) is associated with altered dynamics of the mitral valve apparatus. Accurate characterization of changes in papillary muscle (PM) motion may contribute to better understanding of the specific pathology and thus help presurgical planning. We hypothesized that three-dimensional echocardiography (3DE) may help to address this need. The purpose of this study was to investigate the changes in the distance between PM heads in sagittal (=anterior to posterior leaflet) and coronal (=commissure to commissure) directions in FMR using 3DE.
Methods: In 9 normal subjects and 7 patients with FMR, 3DE datasets of submitral apparatus (volume rate 16±5) were acquired using transesophageal echocardiography from the transgastric approach. Using three-dimensional quantitative software (4D Cardio view, Tom Tec), the coordinates of the point of each PM head (that support the anterior leaflet and the posterior leaflet) were obtained manually and the distance between the two heads was measured throughout the cardiac cycle and plotted using spline interpolation.
Results: The minimum distances between the anterior heads of each PM (p=0.005) and distance between anterior and posterior heads of the posterolateral PM (p=0.001) were larger in patients with FMR than in normal subjects (figure). While in normal subjects this distance decreased in systole and increased in diastole, in FMR patients these time-dependant changes were not obvious (figure).
Conclusion: Three-dimensional echocardiography allows dynamic measurement of the distances between PM heads. These measurements depicted reduced mobility of PM heads in FMR. These findings should be considered while planning mitral valve repair in FMR.
- © 2013 by American Heart Association, Inc.