ニシムラ ヨウスケ   Nishimura Yosuke
  西村 陽介
   所属   医学部医学科  臨床医学系 心臓血管外科学
   職種   教授
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation.
掲載誌名 正式名:Circulation
略  称:Circulation
ISSNコード:15244539/00097322
掲載区分国外
巻・号・頁 126(11 Suppl 1),S214-21頁
著者・共著者 Otani Kyoko, Takeuchi Masaaki, Kaku Kyoko, Haruki Nobuhiko, Yoshitani Hidetoshi, Eto Masataka, Tamura Masahito, Okazaki Masahiro, Abe Haruhiko, Fujino Yoshihisa, Nishimura Yousuke, Levine Robert A, Otsuji Yutaka
発行年月 2012/09
概要 BACKGROUND:In patients with mitral valve prolapse, nonprolapsed leaflets are often apically tented. We hypothesized that secondary left ventricular dilatation attributed to primary mitral regurgitation (MR) causes papillary muscle (PM) displacement, resulting in this leaflet tenting/tethering, and that secondary tethering further exacerbates malcoaptation and contributes to MR severity.METHODS AND RESULTS:Three-dimensional transesophageal echocardiography was performed in 25 patients with posterior mitral leaflet prolapse with an intact anterior mitral leaflet (AML) and 20 controls. From 3D zoom data sets, 11 equidistant antero-posterior cut planes of the mitral valve at midsystole were obtained. In each plane, tenting area of nonprolapsed leaflet and prolapse area of prolapsed leaflet were measured. Prolapse/tenting volume of each region was obtained as the product of interslice distance and the prolapse/tenting area. AML tenting volume and whole leaflet prolapse/tenting volume were then obtained. The PM tethering distance between PM tips and anterior mitral annulus was measured from 3D full-volume data sets. The severity of MR was quantified by vena contracta area extracted from color 3D transesophageal echocardiography data sets. AML tenting volume was significantly larger in patients with posterior mitral leaflet prolapse compared with that in controls (1.2 ± 0.5 versus 0.6 ± 0.2 mL/m(2); P<0.001). Multivariate regression analysis identified independent contribution to AML tenting volume from an increase in PM tethering distance. Multivariate regression analysis identified independent contributions to MR severity (vena contracta area) from both whole leaflet tenting volume (r=0.44; P<0.05) and prolapse volume (r=0.44; P<0.05). AML tenting volume decreased along with left ventricular volume and PM tethering distance postrepair (n=8; P<0.01).CONCLUSIONS:These results suggest that primary mitral valve prolapse with MR causes secondary mitral leaflet tethering wit
DOI 10.1161/CIRCULATIONAHA.111.084178
PMID 22965986