Relationship of Mitral Annular Remodeling to Severity of Chronic Mitral Regurgitation

Assessment of mitral apparatus in patients with acute inferoposterior myocardial infarction and ischaemic mitral regurgitation with two-dimensional echocardiography from anatomically correct imaging planes

“…Based on these findings, in this study mitral valve geometry was assessed in patients with inferoposterior MI. Our analysis and others have previously shown that IMR after acute MI is associated with worse LV function, greater LV enlargement, and MA parameter deformation [19,20]. This study is one of the first that investigates MA geometry in patients with no or severe MR in acute phase of inferoposterior MI from anatomically correct imaging planes.…”

“…The mitral annulus after MI undergoes a number of structural changes in IMR, becoming larger and flatter [5,20,21]. An increase in size causes the effacement of the mitral leaflets compromising coaptation length.…”

Dynamic Changes of the Mitral Valve Annulus

“…(16) In patients with MVP and no or mild MR, annular flattening likely might suggest primary annular pathology in DMD. (17) However, annular enlargement (with consequent flattening) may reflect the multi-segmental extent of prolapse in DMD compared with the limited segment in FED: prolapse can cause annular dilatation by exerting increased outward forces on the annulus, creating an imbalance in annular tension and myocardial force. (18) Confirming primary annular changes may benefit from familial genetic studies of whether annular abnormalities precede or segregate with MVP.…”

The Unsaddled Annulus

“…16 The underlying concept of a mechanically linked mitral mechanism extending from annulus to ventricular wall is supported by the evidence for force transmission within that system and provides the rationale for chordal preservation in MV replacement. 17–19 …”