Echocardiographic evaluation of mitral valve regurgitation

Smer, Aiman; Nanda, Navin C.; Akdogan, Raziye E.; Elmarzouky, Zeyad M.; Dulal, Subash

doi:10.20517/2574-1225.2020.36

Cited by 4 publications

(4 citation statements)

References 36 publications

(42 reference statements)

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“…TTE also gives information on left atrium and ventricle remodeling, estimation of LV diastolic pressure and pulmonary systolic pressure derived from tricuspid regurgitation and right atrial pressure. Transesophageal echocardiography (TEE) is the most sensitive tool for MR quantification and anatomical structure description because the mitral valve is a posterior structure and TEE probe is much closer in the near field of the TEE imaging plane compare to TTE 36 . Therapeutic decision making in MVP and significant MR is well defined by current guidelines 15 but this is not the topic of the present paper.…”

Section: Complex Ventricular Arrhythmias Sudden Cardiac Arrest and Mvpmentioning

confidence: 96%

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Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step

et al. 2022

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Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%–2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called “malignant MVP” characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c‐VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with “arrhythmic MVP” (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T‐wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE‐CMR and anatomy studies. TTE could be a co‐partner in phenotyping high‐risk arrhythmic MVP patients.

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Section: Complex Ventricular Arrhythmias Sudden Cardiac Arrest and Mvpmentioning

confidence: 96%

“…Clinically, MVP can be classified as primary or non-syndromic MVP (sporadic or familial forms) and secondary or syndromic MVP (associated with connective tissue disorder 36 Therapeutic decision making in MVP and significant MR is well defined by current guidelines 15 but this is not the topic of the present paper.…”

Section: Mitral Valve Prolapsementioning

confidence: 99%

Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step

et al. 2022

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“…They were considered three degrees of MR corresponding to EROA ¼ 0:26 cm 2 , EROA ¼ 0:39 cm 2 , and EROA ¼ 0:52 cm 2 , respectively, for mild, moderate, and severe. [21][22][23][24][25] For each of them, the same modulation of asymmetry was analyzed, for a total of 25 Â 3 simulations.…”

Section: A Geometriesmentioning

confidence: 99%

Mitral valve asymmetry in healthy, pathological, and repaired cases

Collia

2021

Physics of Fluids

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The entry of blood into the left ventricle is regulated by the two valve leaflets. Mitral valve prolapse is the primary cause of mitral regurgitation. Mitral valve repair is the gold standard therapeutic procedure for patients with degenerative mitral valve regurgitation and follows two fundamental principles: restoring a good coaptation surface of the flap and correcting annular dilation. This study presents a first step in the direction of addressing the influence of valve geometry on valve fluid dynamics and mitral regurgitation. To this end, it develops a systematic analysis to identify how the level of regurgitation and the efficiency of flow transit in the left ventricle depend on the degree of asymmetry of the leaflets. The analysis is performed starting from a mathematically designed mitral valve and then extended to the actual valves extracted from medical imaging. The specific objective is to evaluate the changes in mitral regurgitation associated with the symmetrical properties of the mitral valve. The broader aim is to begin building physics-based means for evaluating repair options and prosthetic design. Results showed that valve shape does not affect flow; sub-volumes are similar to inflow and vary to outflow due to the presence of false regurgitation under healthy/repaired conditions and regurgitation under pathological conditions affecting the amount of direct flow, delayed and finally the Stroke volume. The best valve asymmetry point was found to be 0.25, while the optimal range was between 0.4 and 0.2, giving an important suggestion to valve surgery.

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“…In clinical practice, 2D transthoracic echocardiography (2D TTE) constitutes the gold standard for the evaluation of valvular heart disease, including MVP, and allows the early non-invasive assessment of the etiology and mechanism [6]. Doppler techniques, in turn, provide an accurate assessment of mitral regurgitation severity [7].…”

Section: Introductionmentioning

confidence: 99%

The Potential of Intertwining Gene Diagnostics and Surgery for Mitral Valve Prolapse

Iske,

Roesel,

Cesarovic

et al. 2023

JCM

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Mitral valve prolapse (MVP) is common among heart valve disease patients, causing severe mitral regurgitation (MR). Although complications such as cardiac arrhythmias and sudden cardiac death are rare, the high prevalence of the condition leads to a significant number of such events. Through next-generation gene sequencing approaches, predisposing genetic components have been shown to play a crucial role in the development of MVP. After the discovery of the X-linked inheritance of filamin A, autosomal inherited genes were identified. In addition, the study of sporadic MVP identified several genes, including DZIP1, TNS1, LMCD1, GLIS1, PTPRJ, FLYWCH, and MMP2. The early screening of these genetic predispositions may help to determine the patient population at risk for severe complications of MVP and impact the timing of reconstructive surgery. Surgical mitral valve repair is an effective treatment option for MVP, resulting in excellent short- and long-term outcomes. Repair rates in excess of 95% and low complication rates have been consistently reported for minimally invasive mitral valve repair performed in high-volume centers. We therefore conceptualize a potential preventive surgical strategy for the treatment of MVP in patients with genetic predisposition, which is currently not considered in guideline recommendations. Further genetic studies on MVP pathology and large prospective clinical trials will be required to support such an approach.

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Echocardiographic evaluation of mitral valve regurgitation

Cited by 4 publications

References 36 publications

Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step

Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step

Mitral valve asymmetry in healthy, pathological, and repaired cases

The Potential of Intertwining Gene Diagnostics and Surgery for Mitral Valve Prolapse

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