Relation of mitral valve morphology and motion to mitral regurgitation severity in patients with mitral valve prolapse

Mario Sénéchal, Nicolas Michaud, Jimmy Machaalany, Mathieu Bernier, Michelle Dubois, Julien Magne, Christian Couture, Patrick Mathieu, Olivier F Bertrand, Pierre Voisine, Mario Sénéchal, Nicolas Michaud, Jimmy Machaalany, Mathieu Bernier, Michelle Dubois, Julien Magne, Christian Couture, Patrick Mathieu, Olivier F Bertrand, Pierre Voisine

Abstract

Background: Mitral valve thickness is used as a criterion to distinguish the classical from the non-classical form of mitral valve prolapse (MVP). Classical form of MVP has been associated with higher risk of mitral regurgitation (MR) and concomitant complications. We sought to determine the relation of mitral valve morphology and motion to mitral regurgitation severity in patients with MVP.

Methods: We prospectively analyzed transthoracic echocardiograms of 38 consecutive patients with MVP and various degrees of MR. In the parasternal long-axis view, leaflets length, diastolic leaflet thickness, prolapsing depth, billowing area and non-coaptation distance between both leaflets were measured.

Results: Twenty patients (53%) and 18 patients (47%) were identified as having moderate to severe and mild MR respectively (ERO = 45 ± 27 mm² vs. 5 ± 7 mm², p < 0.001). Diastolic leaflet thickness was similar in both groups (5.5 ± 0.9 mm vs. 5.3 ± 1 mm, p = 0.57). On multivariate analysis, the non-coaptation distance (OR 7.9 per 1 mm increase; 95% CI 1.72-37.2) was associated with significant MR. Thick mitral valve leaflet as traditionally reported (≥ 5 mm) was not associated with significant MR (OR 0.9; 95% CI 0.2-3.4).

Conclusions: In patients with MVP, thick mitral leaflet is not associated with significant MR. Leaflet thickness is probably not as important in risk stratification as previously reported in patients with MVP. Other anatomical and geometrical features of the mitral valve apparatus area appear to be much more closely related to MR severity.

Figures

Figure 1
Figure 1
Diagram showing measurements of mitral valve geometry of a posterior leaflet prolapse from parasternal long-axis view.
Figure 2
Figure 2
Correlation between prolapsing depth and ERO (effective regurgirtant orifice).
Figure 3
Figure 3
Correlation between billowing area and ERO (effective regurgitant orifice).
Figure 4
Figure 4
Correlation between non-coaptation distance and ERO (effective regurgitant orifice).
Figure 5
Figure 5
Correlation between leaflet thickness and ERO (effective regurgitant orifice).

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