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Degenerative Mitral Regurgitation

  • Wendy TsangEmail author
  • Roberto M. Lang
Chapter

Abstract

Degenerative mitral valve disease consists of a spectrum, with the mildest form recognized as fibroelastic deficiency and the most severe form as Barlow’s disease. Both forms, through different mechanisms, result in thickened leaflet segments that prolapse and billow resulting in mitral regurgitation. These disease processes also lead to changes in mitral annular shape and function. Management of these diseases will differ depending on the extent of valve involvement. Most surgeons can surgically correct mild disease affecting a single P2 segment whereas complex disease affecting both the anterior and posterior leaflets or multiple segments requires an expert mitral valve surgeon. Three-dimensional echocardiography helps determine the location and extent of the lesion. Parametric models are color-encoded topographic displays of mitral valve anatomy from three-dimensional echocardiographic images. These models improve assessment of valve anatomy and provide quantitative measurements that can be used to determine the etiology of the valve abnormality and can therefore be used to direct treatment. Three-dimensional echocardiography also improves quantification of mitral regurgitation severity. This is especially true for degenerative mitral valve disease where the regurgitant orifice is frequently eccentric resulting in an eccentric regurgitant jet. This is achieved by improving the calculation of the effective regurgitant orifice area with vena contracta area or proximal isovelocity surface area, and/or by measuring the true 3D anatomical regurgitant orifice area. Overall, three-dimensional echocardiography improves diagnosis and management of patients with degenerative mitral valve disease.

Keywords

Mitral valve Regurgitation severity quantification Barlow’s disease Fibroelastic deficiency Mitral annulus anatomy Mitral leaflet anatomy Degenerative mitral regurgitation 

Supplementary material

Video 9.1a

(Left) Transthoracic 3DE visualization of a flail P3 scallop with ruptured chordae using a volume rendered en face view of the mitral valve from the atrial perspective (AVI 27551 kb)

Video 9.1b

(Right) Transesophageal 3DE visualization of a flail P3 scallop with ruptured chordae using a volume rendered en face view of the mitral valve from the atrial perspective Left (AVI 2799 kb)

Video 9.2a

(Left) Volume rendered en face view from the atrial perspective of a transesophageal 3DE data set of the mitral valve (A cleft-like indentation of the posterior leaflet is present in P2 (AVI 10823 kb)

Video 9.2b

(Right) volume rendered longitudinal cut plane at A2-P2 level (AVI 8265 kb)

Video 9.3

Volume rendered en face view from the atrial perspective of a transesophageal 3DE data set of the mitral valve in a patient with P2 P3 prolapse and ruptured chords (AVI 9468 kb)

Video 9.4a

(Left) Volume rendered en face view of the mitral valve from the atrial perspective obtained from a 3DE data set in a patient with P2 flail and ruptured chords (AVI 12576 kb)

Video 9.4b

(Right), Volume rendered longitudinal cut plane at the level of A2-P2 obtained from a transthoracic 3DE data set in a patient with P2 flail and ruptured chords (AVI 11750 kb)

192445_2_En_9_MOESM8_ESM.avi (652 kb)
Video 9.5 Volume rendered transesophageal 3DE data set of the mitral valve in a patient with P2 flail and multiple ruptured chords (AVI 651 kb)
Video 9.6

Volume rendered transesophageal 3DE data set of the mitral valve in a patient with ruptured chords and a cleft-like indentation splitting a large P2 prolapse (AVI 1195 kb)

Video 9.7

Volume rendered transesophageal 3DE data set of the mitral valve in a patient with A2 flail and multiple ruptured chords (AVI 2235 kb)

Video 9.8

Volume rendered transesophageal 3DE data set of the mitral valve in a patient with Barlow disease, medial commissural flail and multiple ruptured chords (AVI 603 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Cardiology, Toronto General HospitalUniversity Health Network, University of TorontoTorontoCanada
  2. 2.Noninvasive Cardiac Imaging Laboratories, Department of Medicine/Section of CardiologyUniversity of Chicago Medical CenterChicagoUSA

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