Effect of aortic regurgitant jet direction on mitral valve leaflet remodeling: a real-time three-dimensional transesophageal echocardiography study

Kensuke Hirasawa,Masaki Izumo,Mitsuaki Isobe,Taro Sasaoka,Takashi Ashikaga,Kengo Suzuki,Yoshihiro J Akashi,Tomoo Harada

doi:10.1038/s41598-017-09252-8

Kensuke Hirasawa, Masaki Izumo + Show 6 more

Open Access

https://doi.org/10.1038/s41598-017-09252-8

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Abstract

Chronic aortic regurgitation (AR) induces mitral valve (MV) leaflet enlargement, although, its mechanism still remains unclear. This study aimed to clarify the influence of AR jet directions on the MV apparatus in patients with chronic AR. This study included 69 consecutive patients with severe chronic AR and 17 controls who underwent three-dimensional (3D) transesophageal echocardiography (TEE). The anterior mitral leaflet (AML), posterior mitral leaflet (PML) and MV annulus areas were measured at mid-diastole. All AR patients were classified into the posterior (Group A, n = 38) or non-posterior (Group B, n = 31) group based on the AR jet directions. Both two groups revealed the increased total leaflet areas compared with the controls. No significant differences in the left ventricular volumes, PML or MV annulus area were observed between Group A and B; however, Group A had the larger AML area and greater AML/PML area ratio than Group B (both P < 0.01). The multivariate analysis indicated that the posterior AR jet was independently associated with the AML/PML area (P < 0.01). 3D TEE depicted geometric differences in the MV apparatus between the different types of AR jet directions. These results may be helpful in understanding the mechanism of MV leaflet remodeling in chronic AR.

Highlights

Aortic valve diseases, such as aortic regurgitation (AR) and aortic stenosis, have become relatively common in aging developing countries[1, 2]
No differences in TTE parameters were observed between the two groups
The intraobserver variabilities assessed by ICC were 0.96 for mitral valve (MV) annulus area (95% confidential interval, CI; 0.90 to 0.99), 0.95 for anterior mitral leaflet (AML) area, 0.92 for posterior mitral leaflet (PML) area, and 0.93 for MV opening area

Summary

Introduction

Aortic valve diseases, such as aortic regurgitation (AR) and aortic stenosis, have become relatively common in aging developing countries[1, 2]. The overall prevalence of AR detected by color Doppler echocardiography in adults has been reported 4.9% in the Framingham Heart Study[1] and 10% in the Strong Heart Study[2] These studies have showed that age is an independent predictor of AR; the increased prevalence of AR is presumed in developed countries[1, 2]. We often observe the asymmetrical growth of the MV in patients with AR, in patients with severe eccentric posterior jets. According to these experiences, we assumed that the MV remodeling in patients with AR should be varied by the directions of AR jets. This study aimed to investigate the MV apparatus by using 3D TEE to understand the mechanism of MV morphological changes in patients with chronic AR

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