The online version of this article (doi:10.1186/1476-7120-10-3) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MS is the principal investigator, he concept the study, collected, analysed and interpreted the data and drafted the article, NM, OFB and JM collected and interpreted the data and participated in drafting the manuscript, MB did the statistical analysis and revised the manuscript, MD collected the data and revised the manuscript, JM collected data, CC did a critical revision of the article, PM did mitral valve replacement, PV did mitral replacement, collected data and participated in drafting the manuscript. All authors approved the article.
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.
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.
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).
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.
Additional file 1: Transthoracic echocardiography of a patient with mitral valve prolapse. Transthoracic echocardiography of a patient with mild MR (ERO = 11 mm2) and leaflet thickness > 5 mm. (MOV 599 KB)12947_2011_403_MOESM1_ESM.mov
Additional file 2: Non-coaptation distance measurement of a patient with mitral valve prolapse. Measurement of a non-coaptation distance (2, 4 mm) in the same patient with mild MR. (BMP 1 MB)12947_2011_403_MOESM2_ESM.BMP
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Levine RA, Stathogiannis E, Newell JB, et al: Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol. 1988, 11: 1010-1019. 10.1016/S0735-1097(98)90059-6. CrossRefPubMed
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- Relation of mitral valve morphology and motion to mitral regurgitation severity in patients with mitral valve prolapse
Olivier F Bertrand
- BioMed Central
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