Correlation between Anterior Mitral Leaflet Concavity Area and Ischemic Induced Mitral Regurgitation Severity by Echocardiography

  • Mohammad Asadpour Piranfar Mail Department of Cardiology, Taleghani Hospital, School of Medicine, Shahid Beheshti Univerisyt of Medical Sciences, Tehran, Iran.
Keywords:
Mitral valve annuloplasty, Coronary artery bypass, Echocardiography

Abstract

Functional mitral regurgitation (MR) results from left ventricular remodeling, leaflet tethering or tenting. Coronary artery disease is one of the important causes of functional MR due to tethering. Detection of functional MR and its severity are important factors in patient prognosis. There are different methods for detection of functional MR and its severity, including anterior mitral leaflet concavity area (AMLCA). In this cross sectional study 32 patients, 19 male with three vessel disease (3VD) who were candidate for coronary artery bypass grafting (CABG) with or without mitral valve replacement were selected. The patients had functional MR in ventriculography. AMLCA was determined by long axis view of transthorasic echocardiography (TTE). In this study 32 patients with 3VD and MR were selected (15 mild, 15 moderate and 2 cases with severe MR). The mean age was 62 ± 12 years. In these patients AMLCA were 0.1- 0.43 cm2 in transthorasic echocardiography. The findings of this study showed strong association between anterior mitral leaflet concavity area and functional MR severity (r=0.89) in parasternal long axis (LAX) view of TTE. According to these findings the relation between functional MR and AMLCA was a linear relationship and increase in severity of functional MR was in concordance with increasing of anterior mitral leaflet concavity area (P=0.001). Mitral leaflet concavity area in the parasternal LAX view provides rapid and reliable recognition of functional MR due to coronary artery disease and is quantitatively related to the degree of such MR. We recommend further study with more subjects and ischemic functional MR and AMLCA.

References

Diodato MD, Moon MR, Pasque MK, Barner HB, Moazami N, Lawton JS, Bailey MS, Guthrie TJ, Meyers BF, Damiano RJ Jr. Repair of ischemic mitral regurgitation does not increase mortality or improve longterm survival in patients undergoing coronary arteryrevascularization: A propensity analysis. Ann Thorac Surg 2004;78(3):794-9

Schroder JN, Williams ML, Hata JA, Muhlbaier LH, Swaminathan M, Mathew JP, Glower DD, O'Connor CM, Smith PK, Milano CA. Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting. Circulation 2005;112(9 Suppl):I293-8.

Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Sénéchal M. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation 2007;115(6):782-91.

Nesta F, Otsuji Y, Handschumacher MD, Messas E, Leavitt M, Carpentier A, Levine RA, Hung J. Leaflet,concavity: a rapid visual clue to the presence and mechanism of functional mitral regurgitation. J Am Soc Echocardiogr 2003;16(12):1301-8.

Zipes DP, Braunwald E, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, PA: WB Saunders; 2005.

Lehmann KG, Francis CK, Dodge HT. Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group. Ann Intern Med 1992;117(1):10-7; Erratum in: Ann Intern Med 1992;117(4):349.

Trichon BH, Felker GM, Shaw LK, Cabell CH, O'Connor CM. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003;91(5):538-43.

Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 2001;103(13):1759-64.

Otsuji Y, Gilon D, Jiang L, He S, Leavitt M, Roy MJ, Birmingham MJ, Levine RA. Restricted diastolic opening of the mitral leaflets in patients with left ventricular dysfunction: evidence for increased valve tethering. J Am Coll Cardiol 1998;32(2):398-404.

How to Cite
1.
Asadpour Piranfar M. Correlation between Anterior Mitral Leaflet Concavity Area and Ischemic Induced Mitral Regurgitation Severity by Echocardiography. Acta Med Iran. 49(6):364-367.
Section
Articles