Key result
Cleft-like indentations were identified by 3D echocardiography in 35% of patients with myxomatous mitral valve disease and were associated with a smaller mitral annulus area (1289 vs 1619 mm2, p=0.008).
Why the study?
Does 3D transoesophageal echocardiography accurately diagnose cleft-like indentations in patients with myxomatous mitral valve disease compared to surgical inspection?
Observational (n=49)
Does 3D transoesophageal echocardiography accurately diagnose cleft-like indentations in patients with myxomatous mitral valve disease compared to surgical inspection?
Absolute Event Rate: 1289% vs 1619%
p-value: p=0.008
3D transoesophageal echocardiography accurately identifies cleft-like indentations in myxomatous mitral valve disease, revealing they are associated with smaller annular and leaflet dimensions rather than excess prolapse.
Cleft-like indentations may mark a distinct myxomatous mitral valve subgroup with smaller annuli; hypothesis-generating and should not yet change practice.
OBJECTIVES: Cleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing diagnostic accuracy and defining mechanisms of CLI in patients undergoing surgery for MMVD. METHODS: 3DTOC of mitral valve was acquired in 49 patients with MMVD and severe regurgitation prior to valve repair. Qualitative review compared 3DTOC diagnosis of CLI with surgical inspection. Mitral, annular and leaflet dimensions were quantified with dedicated software and compared between those with and without CLI. RESULTS: Diagnosis of CLI was made by 3DTOC in 17 (35%) while none was identified by 2D and was confirmed in 15 (88%) by surgical inspection. Mechanistically, LV diameters and mitral regurgitant volume (RVol) were similar with and without CLI (p>0.49). Conversely, mitral annulus was smaller with CLI (anteroposterior diameter 42.2±7.1 vs 47.0±7.5 mm, p=0.04; circumference 133±16 vs 148±19 mm, p=0.009; area 1289±326 vs 1619±427 mm(2), p=0.008). Prolapse volume tended to be smaller with CLI (1.9±1.2 vs 4.0±4.3 mL, p=0.06) involving single posterior scallop at surgery (82% vs 44%, p=0.007) with smaller 3DTOC leaflet area (1574±409 vs 2019±652 mm(2), p=0.01). During valve repair, surgical closure of all surgically diagnosed CLI was required. CONCLUSIONS: Posterior leaflet CLI are frequent in MMVD, are identified by 3DTOC with high accuracy and require closure during valve repair. CLI are mechanistically not related to excess annular enlargement or excess prolapse. Conversely, CLI occur in the context of single scallop prolapse with tissue paucity causing excess separation of scallops. These 3DTOC data enhance diagnostic and mechanistic comprehension of the diversity of MMVD phenotypical presentation.
No takes yet. Share an insight, caveat, or question.
Mantovani et al. (2015) conducted an observational in Myxomatous mitral valve disease (MMVD) with severe regurgitation (n=49). Cleft-like indentations (CLI) vs. Without CLI was evaluated on Mitral annulus area (mm2) (p=0.008). Cleft-like indentations were identified by 3D echocardiography in 35% of patients with myxomatous mitral valve disease and were associated with a smaller mitral annulus area (1289 vs 1619 mm2, p=0.008).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: