Novel Mechanistic Insights Into Atrial Functional Mitral Regurgitation　– 3-Dimensional Echocardiographic Study –

Machino‐Ohtsuka, Tomoko; Seo, Yoshihiro; Ishizu, Tomoko; Sato, Kimi; Sugano, Akinori; Yamamoto, Masayoshi; Hamada‐Harimura, Yoshie; Aonuma, Kazutaka

doi:10.1253/circj.cj-16-0435

Cited by 76 publications

(56 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…LA dilatation may be another possible mechanism of AML tethering. Recent clinical studies have shown that LA dilatation with chronic atrial fibrillation causes not only annulus dilatation, but also leaflet tethering, which further aggravates atrial functional MR . However, in the present study, no significant correlations were found between LV/LA size and AML angle, with only LVEF showing a weak, but significant, negative correlation with AML angle in regard to preoperative cardiac function.…”

Section: Discussioncontrasting

confidence: 89%

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Sakaguchi

Kagiyama

Toki

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundCarpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation (MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair.Methods and ResultsWe retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P=0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter (P<0.001) and lower left ventricular ejection fraction (P=0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation.ConclusionsAnterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3‐dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy.

show abstract

Section: Discussioncontrasting

confidence: 89%

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Sakaguchi

Kagiyama

Toki

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Recently, atriogenic leaflet tethering has been speculated to be an important mechanism of atrial functional MR . Left atrial dilatation induces displacement of the posterior mitral annulus onto the crest of the LV inlet, which causes the PML to be tightly pulled against the LV inlet, thereby reducing the leaflet area available for coaptation.…”

Section: Discussionmentioning

confidence: 99%

Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation

et al. 2019

View full text Add to dashboard Cite

Background Surgical ring annuloplasty is generally performed in patients with symptomatic atrial functional mitral regurgitation (MR) caused by long‐standing atrial fibrillation (AF). However, its clinical results have not been well reported. Methods Twenty consecutive patients with atrial functional MR (mean age of 68 ± 9 years) and a left ventricular (LV) ejection fraction (EF) greater than 50% underwent mitral annuloplasty. Concomitant procedures included tricuspid valve surgery in 16 patients, AF ablation in 13 patients, and coronary artery bypass grafting in 2 patients. We reviewed the clinical outcomes of those patients and investigated the specific preoperative echocardiographic findings related to MR recurrence. Results At discharge, the mean left atrial (LA) volume index and mean tricuspid regurgitation peak gradient had significantly decreased from 94 ± 59 mL/m 2 to 58 ± 30 mL/m 2 and from 34 ± 11mm Hg to 23 ± 5mm Hg, respectively. During the follow‐up period of 28 ± 17 months, the New York Heart Association functional class significantly improved from 2.3 ± 0.6 to 1.3 ± 0.6. Four patients developed recurrent MR, and of those, two required reoperation. Those with recurrent MR had a significantly larger preoperative LV dimension than those without recurrent MR. Preoperative three‐dimensional transesophageal echocardiography was performed in 12 patients, revealing a greater degree of leaflet tethering in patients with recurrent MR than that in patients without recurrent MR. Conclusions In patients with the combination of atrial functional MR, left ventricular dilatation and excessive leaflet tethering, mitral annuloplasty alone may not be sufficient to achieve long‐term correction of MR.

show abstract

“…To leave the ventricle, these structures must mount the crest of the LV inlet. In addition, several studies 8,11,12 have noted that the height of the PML is small in patients with AF-MR. Moreover, as can be seen in Figure 1B, enlargement of the LA displaces the plane of the mitral annulus superiorly.…”

Section: Atri Og Eni C Le Afle T Te Theringmentioning

confidence: 99%

“…11,12 In this instance, the base of the atrium and the posterior annulus may become displaced onto the epicardial surface of the posterobasal segment of the LV, 13 further decreasing the PML surface area available for coaptation. 11,12 In this instance, the base of the atrium and the posterior annulus may become displaced onto the epicardial surface of the posterobasal segment of the LV, 13 further decreasing the PML surface area available for coaptation.…”

Section: Hams Tring Ing Of the Pml Due To Par Adoxic Al LV P Os Termentioning

confidence: 99%

“…9 As was noted, the mitral leaflets usually rest in the plane of the annulus 28 or are slightly tethered into the LV cavity. In contrast, PML restriction due to atriogenic leaflet tethering/hamstringing usually causes MR that is posteriorly directed 8,11,30 (Figure 4). In contrast, PML restriction due to atriogenic leaflet tethering/hamstringing usually causes MR that is posteriorly directed 8,11,30 (Figure 4).…”

Section: Echo C Ard I Og R Aphi C Fe Ature S Of a F -M Rmentioning

confidence: 99%

See 1 more Smart Citation

Mechanistic insights into atrial functional mitral regurgitation: Far more complicated than just left atrial remodeling

Silbiger

2019

Echocardiography

View full text Add to dashboard Cite

Recent studies lend credibility to the notion that lone atrial fibrillation (AF) can cause functional mitral regurgitation (MR), commonly referred to as atrial functional MR (AF-MR). The conventional view holds that left atrial enlargement associated with AF causes annular dilatation which gradually moves the mitral valve leaflets apart resulting in inadequate coaptation and regurgitation. Recent findings, however, suggest that AF-MR is not solely related to left atrial remodeling, but that important structural and functional abnormalities of the left ventricle also play a role in its pathogenesis. K E Y W O R D Sannulo-papillary balance, atrial functional mitral regurgitation, atriogenic leaflet tethering, endothelial-mesenchymal transformation, lone atrial fibrillation, mitral annulus

show abstract

Novel Mechanistic Insights Into Atrial Functional Mitral Regurgitation　– 3-Dimensional Echocardiographic Study –

Cited by 76 publications

References 36 publications

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation

Mechanistic insights into atrial functional mitral regurgitation: Far more complicated than just left atrial remodeling

Contact Info

Product

Resources

About

Novel Mechanistic Insights Into Atrial Functional Mitral Regurgitation – 3-Dimensional Echocardiographic Study –

Cited by 76 publications

References 36 publications

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation

Mechanistic insights into atrial functional mitral regurgitation: Far more complicated than just left atrial remodeling

Contact Info

Product

Resources

About

Novel Mechanistic Insights Into Atrial Functional Mitral Regurgitation　– 3-Dimensional Echocardiographic Study –