Cardiovascular Magnetic Resonance Characterization of Mitral Valve Prolapse
Yuchi Han, MD*,*,
Dana C. Peters, PhD*,
Carol J. Salton, BA*,
Dorota Bzymek, RDCS*,
Reza Nezafat, PhD*,
Beth Goddu, RT(R)(MR)*,
Kraig V. Kissinger, RT(R)(MR)*,
Peter J. Zimetbaum, MD*,
Warren J. Manning, MD*, ,
Susan B. Yeon, MD, JD*
* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Figure 1 Comparison of the Long-Axis View in Control and MVP Patients by TTE and CMR
Control (A to D) and mitral valve prolapse (MVP) (E to H) patients. The two-dimensional transthoracic echocardiography (TTE) parasternal long-axis views (A, B, E, F) and cardiovascular magnetic resonance (CMR) left ventricle (LV) outflow tract views (C, D, G, H). (A, C, E, G) Diastole; (B, D, F, H) systole. In panel H, arrows indicate the prolapsed distance measured by the maximum distance of the prolapsed leaflet to the mitral annular plane. LA = left atrium.
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Figure 2 The LVOT Stack Prescription and 2 Examples
(A) Left ventricular outflow tract (LVOT) stack prescription is created by obtaining parallel slices across the mitral valve perpendicular to the long axis of the valve. (B) The LVOT stack from a patient with A1, P1, A2, and P2 prolapses. (i) A1/P1, (ii) and (iii) A2/P2, (iv) A3/P3. (C) The LVOT stack from a patient with prolapse of all scallops and a centrally directed mitral regurgitation jet. Ao = aorta; MV = mitral valve; PA = pulmonary artery; RA = right atrium.
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Figure 3 Mitral Leaflet Thickness
(A) The LVOT view showing leaflet thickness measurements obtained at the thickest portion of the leaflet during diastole. (B) Plot of all leaflets (including both anterior and posterior) by CMR versus TTE. (Line) Linear regression as described in text. The TTE measurements are generally higher than the CMR measurements. Abbreviations as in Figures 1 and 2.
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Figure 4 Indexed Mitral Leaflet Lengths
(A) The LVOT view showing both leaflet length measurements in diastole. (B) Plot of CMR versus TTE indexed leaflet length (including both anterior and posterior). (Line) Linear regression as described in text. Abbreviations as in Figures 1 and 2.
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Figure 5 Indexed MADs
(A) The 2- and 4-chamber views of the end-systolic long-axis mitral annular diameter (MAD) measurement. (B) The LVOT view of the end-systolic short axis MAD measurement. (C) Plot of CMR versus TTE indexed MAD (including both long- and short-axis). (Line) Linear regression as described in text. Abbreviations as in Figures 1 and 2.
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Figure 6 Mitral Valve LGE
(A, B) Control subject steady state free processing (SSFP) and late gadolinium enhancement (LGE) images at the short axis valve plane. In LGE, a very faint bright line represents normal valve leaflets. Panel C shows the SSFP image of a MVP patient with thickened leaflets. Panel E shows the SSFP image of another MVP patient who does not have readily identifiable leaflets. Panels D and F show the corresponding 3-dimensional LGE-CMR images with enhancement in the anterior leaflets (black arrows) and posterior leaflets (white arrows) in both patients. Abbreviations as in Figure 1.
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Figure 7 Mitral Papillary Muscle LGE
(A to D) Short axis SSFP, two-dimensional (2D) LGE-CMR, and high-resolution three-dimensional (3D) LGE-CMR images of 1 MVP patient at the mid-papillary muscle level. Arrows point to LGE. (E to H) Images from another MVP patient. (E) Short-axis SSFP. (F) A 2D LGE-CMR image with (arrow) "partial loss" of papillary muscle from volume averaging. (G) A 3D LGE-CMR. (H) A 3D multiplanar reconstruction confirming enhancement in the papillary muscle. Arrows point to LGE in the papillary muscle.
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