3D Xplane Echocardiographic Technique for Validation of Mitral Leaflet Separation to Assess Severity of Mitral Stenosis

Between March 1994 and December 1995 a total of 27 cases of mitral valve anterior leaflet repair were undertaken at our institution. Five of the patients were excluded from the study; 3 with predominant mitral stenosis and 2 with atrial septal defect primum type. Of the 22 anterior mitral leaflet repair patients, there were 12 males and 10 females with a mean age of 41.5 years. Follow-up was complete in all patients and ranged from 2 to 22 months with a mean of 8.6 months. Mitral valve disease was attributed to rheumatic disease in the majority of cases (12). Other causes included degenerative (5), endocarditis (2), ischemic (2), and congenital conditions (1). Preoperatively there, were 18 cases of mitral regurgitation, and 4 of mixed mitral stenosis and regurgitation. The most commonly used surgical procedures were prosthetic ring implantation, chordal shortening and chordal transposition. Most of the patients required multiple procedures to accomplish the repair with an average of 3.4 procedures per patient. Neochordal implantation with polytetrafluoroethylene was performed in 4 cases. Reconstruction of the anterior mitral leaflet using autologous glutaraldehyde-treated pericardium was completed in 2 patients who had bacterial endocarditis. There were no hospital deaths nor late mortality in this series. None of the patients required reoperation during the follow-up. The patients' functional status as well as the severity of the mitral regurgitation improved markedly after the operation. We conclude from our study that repair of the mitral valve anterior leaflet is possible in selected patients with good early results.

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O138 Assessment Of Severity Of Mitral Stenosis Before And After Percutaneous Transvenous Mitral Commissurotomy By Using Mitral Leaflet Separation Index

Global Heart ◽

10.1016/j.gheart.2014.03.1348 ◽

2014 ◽

Vol 9 (1) ◽

pp. e38

Author(s):

Md.Toufiqur Rahman

Keyword(s):

Mitral Stenosis ◽

Mitral Leaflet ◽

Separation Index ◽

Before And After ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy

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Posterior mitral leaflet motion in mitral stenosis.

Circulation ◽

10.1161/01.cir.51.3.511 ◽

1975 ◽

Vol 51 (3) ◽

pp. 511-514 ◽

Cited By ~ 24

Author(s):

J A Levisman ◽

A S Abbasi ◽

M L Pearce

Keyword(s):

Mitral Stenosis ◽

Mitral Leaflet ◽

Posterior Mitral Leaflet ◽

Leaflet Motion

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Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index

Nepalese Heart Journal ◽

10.3126/njh.v16i2.26316 ◽

2019 ◽

Vol 16 (2) ◽

pp. 41-46

Author(s):

Rajan Paudel ◽

Ram Kishor Sah ◽

Man Bahadur KC ◽

Deewakar Sharma ◽

Arun Maskey ◽

...

Keyword(s):

Mitral Valve ◽

Strong Correlation ◽

Mitral Stenosis ◽

Mitral Leaflet ◽

Cross Sectional ◽

Mitral Valve Leaflet ◽

Separation Index ◽

Mitral Valve Area ◽

Stenosis Severity ◽

Valve Area

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.

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ASSESSMENT OF SEVERITY OF MITRAL STENOSIS BEFORE AND AFTER PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY BY USING MITRAL LEAFLET SEPARATION INDEX

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)61755-1 ◽

2014 ◽

Vol 63 (12) ◽

pp. A1752

Author(s):

Md. Toufiqur Rahman

Keyword(s):

Mitral Stenosis ◽

Mitral Leaflet ◽

Separation Index ◽

Before And After ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy

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Echocardiographic analysis of posterior mitral leaflet movement in mitral stenosis.

Heart ◽

10.1136/hrt.40.4.372 ◽

1978 ◽

Vol 40 (4) ◽

pp. 372-376 ◽

Cited By ~ 3

Author(s):

M F Shiu ◽

B S Jenkins ◽

M M Webb-Peploe

Keyword(s):

Mitral Stenosis ◽

Mitral Leaflet ◽

Posterior Mitral Leaflet

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Pathology of Severe Mitral Regurgitation following Balloon Valvuloplasty

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500106 ◽

1997 ◽

Vol 5 (1) ◽

pp. 25-30 ◽

Cited By ~ 2

Author(s):

Shiv Kumar Choudhary ◽

Anil Bhan ◽

Rajesh Sharma ◽

Balram Airan ◽

Bhabhananda Das ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Severe Mitral Regurgitation ◽

Mitral Leaflet ◽

Mitral Valvuloplasty ◽

Mitral Valves ◽

Posterior Mitral Leaflet ◽

Radial Tear ◽

Acute Mitral Regurgitation

This study assessed the mechanism of acute mitral regurgitation following balloon mitral valvuloplasty for the treatment of symptomatic mitral stenosis. We studied 25 patients who required mitral valve replacement for severe mitral regurgitation following balloon mitral valvuloplasty. All the mitral valves studied had features of severe mitral stenosis. Radial tear of the mitral leaflet was responsible for mitral regurgitation in 18 (72%) cases. Of these, 16 involved the anterior mitral leaflet and in 2 cases the posterior mitral leaflet was torn. Three patients (12%) had chordal rupture, whereas in 4 (16%) patients pseudo-orifices were formed. All the excised mitral valves showed significant subvalvular deformity which was underestimated in prevalvuloplasty echocardiography. No other factor was found to be associated with disruption of the valve. Hence, we conclude that cusp deformity and subvalvular pathology are responsible for faulty transmission of forces and improper engagement of the balloon, resulting in disruption of the valvular apparatus. The incidence of severe mitral regurgitation following balloon mitral valvuloplasty might be decreased by appropriate prevalvuloplasty assessment and patient selection.

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