Changes in mitral annulus and leaflets size are related to regurgitation severity in organic mitral regurgitation: a three-dimensional transthoracic study

Abstract

Background: Until recently, quantitative analysis of mitral valve annulus (MVA) dimensions in different types of mitral regurgitation (MR) was feasible only by transesophageal 3D echocardiography (3DE); data about the relationship of these quantitative parameters to MR severity are scarce. Objectives: Our aim was to assess if the changes in mitral annulus and leaflets of patients with organic MR are related to MR severity. Methods: 30 pts with moderate-severe organic MR (OMR) due to MV prolapse (57±14 yrs, 21 men, 28 pts with posterior leaflet prolapse) underwent 3D full-volume acquisition of the MV (32±2 fps) using Vivid E9 (BT 12, GE Healthcare, Horten, N). MR severity was quantitatively assessed according to current guidelines: vena contracta (VC), PISA radius (PISArad), effective regurgitant orifice (ERO), and MR volume (MRvol). Left atrial biplane volume was also measured. Several MV geometry parameters were measured at mid-systole with prototype software for 3DTTE (TomTec MV assessment 2.0, Unterschleissheim, D): antero-posterior annulus diameter (A-P diameter), anterolateral-posteromedial annulus diameter (AL-PM diameter), commissural diameter, 3D annulus circumference and area, anterior and posterior leaflet areas (ALA, PLA). Results: 3D annulus area and circumference correlated to PISArad (r=0.455, p=0.027; r=0.477, p=0.027), and MRvol (r=0.610, p=0.009; r=0.584, p=0.014) (Figure). Due to dominance of posterior leaflet prolapse, PLA was also related to MRvol (r=0.526, p=0.003). Moreover, a positive relationship was found between biplane LA volume and MVA area (r=0.630, p=0.001). ![Figure][1] Correlation for MVA size and MR severity Conclusion: In organic MR, quantitative analysis of MVA geometry by 3D TTE revealed that increased dimensions of MV leaflets and annulus, in addition to MV morphology, contribute to MR severity and LA volume. [1]: pending:yes