Mitral leaflet separation index for mitral valve assessment during balloon mitral valvuloplasty

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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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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Role of Mitral Leaflet Separation Index (MLSI) in Determining Mitral Stenosis Severity

Indonesian Journal of Cardiology ◽

10.30701/ijc.v36i4.501 ◽

2016 ◽

pp. 186-95

Author(s):

I Made Junior Rina Artha ◽

Amiliana M Soesanto ◽

Indriwanto Sakidjan ◽

Ganesja M Harimurti

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Leaflet ◽

Cross Sectional ◽

Simple Method ◽

Separation Index ◽

Mitral Valve Area ◽

Stenosis Severity ◽

Severe Calcification ◽

Valve Area

Objective. To Correlate MLSI with 3-D mitral valve area (MVA) planimetry in determining mitral stenosis (MS) severity.Background. Mitral Stenosis (MS) is still a major problem in cardiology, and causes of morbidity dan mortality worldwide. Echocardiogrphy plays an important role in assessing mitral stenosis severity. Mitral leaflet separation index (MLSI) is one of simple method that can be used in peripheral by using common ultrasound to assess the severity mitral stenosis.Methods. We employed a cross sectional study. Mitral stenosis patients who referred for evaluation echocardiography in National Cardiac Center Harapan Kita from April to September 2011. MLSI was obtained by averaging the maximal leaflet separation distance at the tips in diastole in parasternal long-axis and apical four- chamber views. 3-Dimensional (3-D) mitral valve area (MVA) planimetry as a reference. The only exclusion criteria was severe calcification and poor echo window. Echocardiography examination using Philips E33i.Results. Seventy six consecutive patients were enrolled, 5 subjects were excluded from study because of severe calcification and poor echo window. Proportion of woman is 73.2 % and mostly in age group < 40 years old (43.7 %). Severe mitral stenosis was dominate the subject, 47 subject (66.2 %), moderate was 19 subject (26.8 %), and mild only 5 subjects (7.0 %). Analysis with Spearman correlations obtained a good correlation with r = 0.70, p < 0.001, good correlation was found in sinus rhythm with r = 0.78, p < 0.001 and atrial fibrillation with r = 0.79, p < 0.001. MLSI less than 0.69 cm predicted severe MS with 85 % sensitivity and 82.4 % specificity.Conclusions. Mitral leaflet separation index (MLSI) has a good correlation with 3-D MVA planimetry. MLSI less than 0.69 cm can estimate severe SM.

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Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty

The Egyptian Heart Journal ◽

10.1016/j.ehj.2018.04.006 ◽

2018 ◽

Vol 70 (3) ◽

pp. 195-201 ◽

Cited By ~ 2

Author(s):

Sameh S. Raafat ◽

Ali A. Ramzy ◽

Amr F. El-Hadidy ◽

Mohamed A. Abd Allah ◽

Hany F. Hanna

Keyword(s):

Mitral Valve ◽

Two Dimensional ◽

Mitral Leaflet ◽

Mitral Valvuloplasty ◽

Mitral Valve Area ◽

Percutaneous Balloon ◽

Before And After ◽

Dimensional Echocardiography ◽

Two Dimensional Echocardiography ◽

Valve Area

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Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(00)01184-0 ◽

2001 ◽

Vol 37 (3) ◽

pp. 900-903 ◽

Cited By ~ 87

Author(s):

José A.M de Souza ◽

Eulogio E Martinez ◽

John A Ambrose ◽

Claudia M.R Alves ◽

Daniel Born ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Valvuloplasty ◽

Percutaneous Balloon Mitral Valvuloplasty ◽

Percutaneous Balloon

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Mitral valve Replacement in a 4 yrs old Child: First Time in Bangladesh

Cardiovascular Journal ◽

10.3329/cardio.v6i2.18362 ◽

2014 ◽

Vol 6 (2) ◽

pp. 167-169

Author(s):

MR Hoque ◽

MSA Sunny ◽

MM Rahman

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Symptomatic Improvement ◽

Complex Congenital Heart Disease ◽

Lv Function ◽

Mitral Leaflet ◽

Posterior Mitral Leaflet ◽

Total Preservation ◽

First Time

Congenital mitral valve incompetence is a rare and complex congenital heart disease in children. We report, a case of a 4-year-old child admitted to hospital with fever, dyspnea on exertion or feeding and repeated respiratory infection for last 3 years. The transthoracic echocardiogram revealed grossly dilated left atrium and left ventricle and severe mitral regurgitation due to cleft in anterior mitral leaflet. Per-operatively mitral valve annulus was found very much dilated; leaflet thinned out and rudimentary posterior mitral leaflet. Morphology of mitral valve was totally distorted, leaflets were diminutive and beyond repairable. Mitral valve replacement was done with 25 mm Edward Life Science porcine tissue heart valve with total preservation of subvalvular structure and the patient showed dramatic symptomatic improvement and later follow up revealed good LV function with alleviation of symptoms. This is a rare and unusual case of congenital mitral valve disease with better prognosis after surgical replacement with tissue valve. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18362 Cardiovasc. j. 2014; 6(2): 167-169

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