Author + information
- Received July 6, 2011
- Revision received September 28, 2011
- Accepted October 11, 2011
- Published online April 1, 2012.
- Ken Saito, MD,
- Hiroyuki Okura, MD⁎ (, )
- Nozomi Watanabe, MD,
- Kikuko Obase, MD,
- Tomoko Tamada, MD,
- Terumasa Koyama, MD,
- Akihiro Hayashida, MD,
- Yoji Neishi, MD,
- Takahiro Kawamoto, MD and
- Kiyoshi Yoshida, MD
- ↵⁎Reprint requests and correspondence:
Dr. Hiroyuki Okura, Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
Objectives The purposes of this study were to examine whether tethering of the mitral leaflets affects coaptation in patients with functional mitral regurgitation (FMR) and to assess the interaction between the mitral coaptation and mitral regurgitation severity.
Background Functional mitral regurgitation causes restriction of leaflet closure as a result of enhanced tethering of the mitral leaflets and papillary muscle (PM) displacement.
Methods Three-dimensional transesophageal echocardiography was performed in 44 patients with FMR related to the bilateral PM displacement and in 56 controls. The distance between the tip of the anterior or posterior PM and the intervalvular fibrosa were measured as the lateral or medial tethering length (TL) in midsystole. To evaluate the degree of coaptation, coaptation length (CL) at medial, middle, and lateral sites of mitral valve and an estimate of coaptation area (CA) were measured.
Results The FMR group showed the significantly decreased CA (1.3 ± 0.4 cm2 vs. 1.6 ± 0.4 cm2, p = 0.005) and CL (medial 3.2 ± 0.9 mm vs. 4.8 ± 0.6 mm, middle 3.8 ± 1.3 mm vs. 5.8 ± 0.7 mm, lateral 3.3 ± 0.9 mm vs. 4.8 ± 0.6 mm; all p < 0.0001) compared with the controls. Each CL correlated negatively and significantly with both medial and lateral TL (all p < 0.0001). Annular area (p = 0.004) was significantly smaller and leaflet-to-annular area ratio (p < 0.0001) was significantly larger in patients with nonsignificant FMR than in the patients with significant (moderate to severe) FMR. Significant correlations were found between effective regurgitant orifice area and CA or each CL (all p < 0.0001).
Conclusions Coaptation decreased significantly in patients with FMR. The CL at each region was related to PM displacement and the indexes of coaptation were associated with mitral regurgitation severity.
- functional mitral regurgitation
- left ventricular remodeling
- mitral valve coaptation
- 3-dimensional transesophageal echocardiography
All authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2011.
- Revision received September 28, 2011.
- Accepted October 11, 2011.
- American College of Cardiology Foundation