Abstract 19331: Quantification of Tethering Patterns in Secondary Mitral Regurgitation by 3D Echocardiography Mitral Valve Mapping
Background: Secondary mitral regurgitation (SMR) results from mitral valve (MV) tethering, typically quantified globally as total area or volume. However, MV tethering pattern is often heterogeneous. We aimed to develop and quantify regional MV tethering “maps” in patients with SMR using 3D transesophageal echocardiography (TEE).
Methods: Thirty three patients with ≥moderate SMR and 19 controls underwent 3D TEE and analyses (Omni4D). MV annulus, leaflet area, coaptation line and tenting height (TH: distance between the annular plane and leaflets) were measured at mid-systole (fig A). Anterior (AL) and posterior (PL) mitral leaflets were divided into three equal segments (A1, A2, A3 and P1, P2, P3) to assess regional MV tethering patterns and leaflet area, and to identify the location of maximal TH (maxTH) (fig A).
Results: Patients with SMR had significantly larger 3D leaflet area and tenting height for both leaflets, as well as for all individual segments of both leaflets (fig B). The leaflet area was 32-37% and mean TH was 118-129% greater than controls. MaxTH was located mostly at the coaptation zone in both SMR patients and controls (75% vs 63%, respectively; p=0.50; fig B). For the AL, maxTH was most frequently located in A1 (53%) vs 26% in A2 and 21% in A3 in controls, whereas, in patients with SMR, the maxTH was equally located in A1 and A2 (both 42%) vs 16% in A3 (fig B). For the PL, maxTH was mainly observed in P1 (42%) in controls vs P2 (49%) in patients with SMR (fig B).
Conclusion: 3D echocardiography allows quantitative mapping of tethered segments in patients with SMR. The tethering patterns of MV leaflets in patients with SMR differs significantly as compared with controls, and also shows an important regional heterogeneity within patients. This important variance provides mechanistic insights for improving MV repair in SMR.
Author Disclosures: R. Capoulade: None. C.G. Mihos: None. M.D. Handschumacher: None. J.G. Teoh: None. X. Zeng: None. Y.H. Park: None. P.E. Bartko: None. D.A. D’Alessandro: None. S. Melnitchouk: None. R.A. Levine: None. J.W. Hung: None.
- © 2016 by American Heart Association, Inc.