By ShotaFukuda, Jae-KwanSong, KeitaroMahara, HiroshiKuwaki, Jeong YoonJang, MasaakiTakeuchi, Byung JooSun, Yun JeongKim, TetsuMiyamoto, YasushiOginosawa, ShinjoSonoda, MasatakaEto, YosukeNishimura, ShuichiroTakanashi, Robert A.Levine and YutakaOtsuji
Possible association of prominent mitral valve annular dilatation with basal predominance of left ventricular (LV) dilatation in patients with mitral...Show More
Possible association of prominent mitral valve annular dilatation with basal predominance of left ventricular (LV) dilatation in patients with mitral valve prolapse (MVP). This characteristic LV geometry may cause regionally augmented wall tension with reduced contraction in the LV base by Laplace’s law. LA indicates left atrium.Show Less
Method to measure basal predominance of left ventricular (LV) dilatation. The LV long-axis dimension was trisected and transverse dimensions of basal, middle, and apical LV were measured in apical 4- and 2-chamber views, respectively. Basal, middle, and apical LV cross-sectional areas (CSAB, CSAM, and CSAA, respectively) were obtained by an elliptical assumption. The ratio of basal to middle·apical LV cross-sectional area (CSAB/0.5×[CSAA+CSAM]) was obtained as an index to express basal predominance of LV dilatation.
A, Proportional basal left ventricular (LV) dilatation (basal/middle·apical LV area ratio) to mitral valve (MV) annular dilatation. B and C, Proportional reduction in basal LV contraction (basal/middle·apical LV strain ratio) to basal LV or MV annular dilatation.
Proportional changes in basal left ventricular (LV) strain and basal/middle·apical LV strain ratio after surgery to preoperative mitral valve (MV) annular area (A and C) and their changes after surgery (B and D).
A representative patient with mitral valve prolapse (MVP) and reduced basal left ventricular (LV) contraction seen as pink signals on color echocardiographic strain imaging (A, large white arrows). This patient also had a prominent mitral valve (MV) annular dilatation (large yellow arrows, dimension=51 mm) and basal-predominant LV dilatation (large white arrows). The corresponding bull’s eye image of LV myocardial longitudinal strain in B shows regionally reduced contraction in the entire LV base (white stars). After surgical MV plasty with annular size reduction (C, small yellow arrows), the preoperatively reduced basal LV contraction disappeared (red signals in C; yellow stars in D) with improved basal LV dilatation (small white arrows in C). These findings suggest a potential relationship between MV annular dilatation and basal LV dilatation and reduced contraction. LA indicates left atrium; RA, right atrium; and RV, right ventricle.
Jae-Sik Jang, Donna M. Buchanan, Kensey L. Gosch, Philip G. Jones, Praneet K. Sharma, Ali Shafiq, Anna Grodzinsky, Timothy J. Fendler, Garth Graham and John A. Spertus
Circulation: Cardiovascular Interventions. 2015;8:e002226, originally published May 12, 2015
