Abstract
Background. Mitral valve prolapse is defined by two-dimensional (2D) echocardiography as an existence when the leaflet exceeds the annular level. However, the annular level set by 2D echocardiography differs in each view because of the saddle-shape of the annulus. In this study, we sought to investigate the degree of mitral valve prolapse from the three-dimensional (3D) dataset, which was created by the newly developed quantitative software system with transthoracic real-time 3D echocardiography, and then compare the data with normal subjects.Methods. Thirteen patients with mitral valve prolapse who were planned to have mitral valve repair (anterior leaflet, 6 patients; posterior leaflet, 7) and 21 healthy subjects were studied. Echocardiographic exams were performed by SONOS 7500 with X4 probe before surgery. Transthoracic volumetric images (full-volume mode) were obtained from the apical view. A newly developed software was used to crop the 3D data, and the mitral annulus and leaflets were traced in each cropped image. 3D images of the mitral leaflets and annulus were then automatically reconstructed for 3D quantitation. Prolapsed leaflet area was defined as the region that exceeded estimated 3D mitral annular level into the left atrium. We analyzed the % prolapsed area (ratio of the prolapsed leaflet area to the mitral annular area), and the maximum prolapse height from the 3D annular level to the maximum prolapsed site.Results. In patients with mitral valve prolapse, % prolapsed area was 20.9±5.8% (anterior 22.5±7.3%, posterior 19.4±4.0%). Maximum prolapse height was 8.4±5.8mm (anterior5.7±2.7mm, posterior10.7±6.9mm). In 16 of 21 healthy subjects, a small degree of prolapse was seen in the middle portion of the anterior scallop (% prolapsed area was 7.96±6.94%, pConclusions. Mitral valve prolapse could be quantitatively assessed by newly developed software system with real-time 3D echocardiography. Investigation of new standard of mitral valve prolapse in 3D insights would be required.
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