Nishimura Yosuke
   Department   School of Medicine  Cardiovascular Surgery, Clinical Medical Sciences
Article types journal article
Language English
Peer review Peer reviewed
Title Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation.
Journal Formal name:Circulation
ISSN code:15244539/00097322
Domestic / ForeginForegin
Volume, Issue, Page 126(11 Suppl 1),S214-21頁
Author and coauthor 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
Publication date 2012/09
Summary 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