Novel echocardiographic classification of mitral valve structure in atrial septal defect of adult and its value on surgical repair for mitral valve

Q: What are the key findings of this study?

Atrial septal defects in adults were associated with significant mitral valve structural abnormalities compared to controls, including reduced posterior leaflet length (8.88 vs 13.23 mm) and coaptation length, and a novel echocardiographic classification successfully guided concurrent surgical repair with only 4.0% developing moderate or severe mitral regurgitation at 1 year.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Septal Defect (ASD) (n=138). Intervention: Atrial septal defect (ASD) vs. Normal intracardiac structure. Primary outcome: Posterior mitral leaflet length (p=<0.001).

Q: What does this research mean for the field?

Adults with atrial septal defects exhibit significant mitral valve structural abnormalities—including reduced posterior leaflet length and coaptation length—and an echocardiographic structural classification effectively guides concurrent mitral valve repair to minimize postoperative regurgitation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate structural differences of the mitral valve in adult patients with atrial septal defect using transesophageal echocardiography and assess their clinical utility for guiding concurrent mitral valve repair.

Yuxi Li; Lin Zhao; Xuezeng Xu; Liang Cao; Guomeng Jiang; Jianlong Yang; Chennian Xu; Liwen Liu; Xin Meng

doi:10.3389/fmed.2026.1861780

August 12, 2026Frontiers in MedicineOpen Access

Novel echocardiographic classification of mitral valve structure in atrial septal defect of adult and its value on surgical repair for mitral valve

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Key result

Adult ASD is linked to ~33% shorter posterior mitral leaflet length and distinct structural abnormalities.

P<0.001
n=138

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Why the study?

Differences in mitral valve structure in adult patients with atrial septal defect and their impact on surgical repair have not been well characterized or classified.

Does a novel TEE-based echocardiographic classification of mitral valve structure in adult patients with ASD assist in guiding concurrent mitral valve repair?

Key Points

To evaluate structural differences of the mitral valve in adult patients with atrial septal defect using transesophageal echocardiography and assess their clinical utility for guiding concurrent mitral valve repair.
Analyzed transesophageal echocardiography data from 75 adult patients undergoing atrial septal defect repair (observation group) and 63 controls with normal intracardiac structures.
Classified mitral valve morphology into four main subtypes (Type 0, Ia, Ib, II, and III) based on leaflet position relative to the annular plane and coaptation length.
Evaluated correlations between mitral valve subtype parameters, defect area, pulmonary-to-systemic blood flow ratio (Qp/Qs), and surgical repair outcomes.
Morphological abnormalities were present in 78.7% (59/75) of atrial septal defect patients compared to controls, with 84.0% having posterior leaflet lengths ≤ 10 mm versus 6.3% in controls (P < 0.001).
Significant differences across subtypes were observed for defect area, Qp/Qs ratio, and anterior leaflet length (all P < 0.05), with defect area positively correlating with Qp/Qs (r = 0.634, P < 0.05).
Concurrent mitral valve repair was performed in 33 patients (including 16 of 19 Type II and all 9 Type III patients), achieving immediate postoperative resolution of mitral regurgitation or no regurgitation.

Study Design

Type

Observational (n=138)

Blinding

Double-blind

Multicenter

No

Structured PICO

Does a novel TEE-based echocardiographic classification of mitral valve structure in adult patients with ASD assist in guiding concurrent mitral valve repair?

P

Population

138 adults (75 with secondary atrial septal defect and 63 controls with normal cardiac structures) evaluated by transesophageal echocardiography, with the ASD group followed for 1 year post-surgery.

E

Exposure

Preoperative 3D transesophageal echocardiography (TEE) to classify mitral valve structural abnormalities (ASD-MV Types 0, Ia, Ib, II, and III) and determine indications for concurrent surgical mitral valve repair alongside ASD closure.

C

Comparator

63 adult patients with normal intracardiac structures and minimal or no mitral regurgitation undergoing TEE for screening of patent foramen ovale (PFO).

O

Outcome

Differences in morphology and structure of the mitral valve (annular diameter, leaflet length, coaptation depth and length) between groups.surrogate

Main Result

Absolute Event Rate: 8.88% vs 13.23%

p-value: p=<0.001

A novel TEE-based morphological classification of the mitral valve in adult ASD patients characterizes structural abnormalities and may assist in determining the need for concurrent surgical mitral valve repair to prevent postoperative mitral regurgitation.

Limitations

Small total sample size and limited case numbers in each classification subgroup.
Single-center retrospective design without a pre-designed reproducibility sub-study or quantitative inter-observer validation.
Qp/Qs values were estimated via TEE rather than the gold standard right heart catheterization.
Control group consisted of patients evaluated for suspected PFO or dizziness rather than fully healthy individuals.
Short follow-up period of 1 year limits evaluation of long-term stability and late recurrence of mitral regurgitation.
Potential confounding bias due to the exclusion of patients with preoperative arrhythmias (like atrial fibrillation).

Implication

May guide concurrent mitral repair decisions in adult ASD; leaves open need for randomized trials to confirm benefit.

Abstract

Objectives To evaluate the differences in mitral valve (MV) structure in adult patients with atrial septal defect (ASD) by transesophageal echocardiography (TEE) and explore the clinical value of these differences in surgical repair for mitral valves. Methods The data related to the mitral valve from 75 adult patients who underwent surgical repair were collected which formed the observation group. The corresponding data from 63 adult patients with normal intracardiac structures and minimal or no mitral regurgitation were collected. The structural differences of the mitral valve between the two groups compared, and ASD-MV based on the degree of these differences were classified. Results There were significant differences in the morphology and structure of the mitral valve between the observation group and the control group. Statistical analysis revealed significant differences in ASD area, Qp/Qs ratio(the ratio of pulmonary to systemic blood flow), and mitral valve anterior leaflet length across ASD-MV subtypes (all P < 0.05). Conclusion This study classified the mitral valve in patients with ASD to assist in determining whether concurrent mitral valve repair is indicated. It significantly reduced the proportion of patients with markedly aggravated mitral regurgitation post-ASD repair, providing a reference for concurrent mitral valve intervention in ASD patients.

Discussion

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Cite This Study

Li et al. (2026) conducted an observational in Atrial Septal Defect (ASD) (n=138). Atrial septal defect (ASD) vs. Normal intracardiac structure was evaluated on Posterior mitral leaflet length (p=<0.001). Atrial septal defects in adults were associated with significant mitral valve structural abnormalities compared to controls, including reduced posterior leaflet length (8.88 vs 13.23 mm) and coaptation length, and a novel echocardiographic classification successfully guided concurrent surgical repair with only 4.0% developing moderate or severe mitral regurgitation at 1 year.

synapsesocial.com/papers/6ad0fc963afa093ea9acfec7 https://doi.org/10.3389/fmed.2026.1861780

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Novel echocardiographic classification of mitral valve structure in atrial septal defect of adult and its value on surgical repair for mitral valve

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Novel echocardiographic classification of mitral valve structure in atrial septal defect of adult and its value on surgical repair for mitral valve

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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