Abstract 20333: Regional Leaflet Tethering Not Annular Size Determines Recurrent Ischemic Mitral Regurgitation After Valve Repair
Background: Mitral valve repair is the preferred treatment for ischemic mitral regurgitation (IMR); however, the high incidence of early failure emphasizes the need for parameters to identify patients at high risk for recurrent IMR. Using real-time (rt-3DE), regional mitral valve parameters were compared to better characterize recurrent and non-recurrent IMR valves.
Methods: Pre-operative three-dimensional echocardiography (3DE) images of 48 IMR valves (35 non-recurrent and 13 recurrent) and 18 normal valves were acquired. Six month follow-up echoes of the IMR patients were obtained to assess competency of the valve post repair. Valve images were segmented as previously published. Customized algorithms were used to determine the septolateral diameter (SLD), mitral annular area (MAA), mitral valve tenting volume (MVTv) referring to the volume enclosed by the annular plane and mitral leaflets, mitral valve tenting index (MVTI) calculated by the MVTv divided by MAA, and tethering angles for each leaflet region. Recurrent IMR was defined as ≥2+.
Results: All parameters were significantly greater in IMR valves compared to controls. Measures of annular size (SLD and MAA) were not significantly different between recurrent and non-recurrent IMR patients (Table 1). The MVTv was not significantly different between IMR groups. MVTv and MVTI were significantly larger in patients with recurrent IMR compared to non-recurrent patients. Recurrent IMR patients demonstrated significantly greater tethering angles especially for the P2, P3, and A3 segments.
Conclusions: All IMR cases had significantly dilated annuli. Recurrence was associated with severe leaflet tethering especially at the posterior commissure.
Author Disclosures: E.K. Lai: None. M.M. Levack: None. S. Takebayashi: None. T.J. Eperjesi: None. P.A. Patel: None. A.T. Cheung: None. Y.J. Woo: None. M.A. Acker: None. B.M. Jackson: None. J.H. Gorman: None. R.C. Gorman: None.
- © 2014 by American Heart Association, Inc.