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Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging

ObjectivesCleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing di... Full description

Journal Title: Heart (British Cardiac Society) 2015-07, Vol.101 (14), p.1111-1117
Main Author: Mantovani, Francesca
Other Authors: Clavel, Marie-Annick , Vatury, Ori , Suri, Rakesh M , Mankad, Sunil V , Malouf, Joseph , Michelena, Hector I , Jain, Sonia , Badano, Luigi Paolo , Enriquez-Sarano, Maurice
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: BMJ Publishing Group Ltd
ID: ISSN: 1355-6037
Link: https://www.ncbi.nlm.nih.gov/pubmed/25935768
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title: Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging
format: Article
creator:
  • Mantovani, Francesca
  • Clavel, Marie-Annick
  • Vatury, Ori
  • Suri, Rakesh M
  • Mankad, Sunil V
  • Malouf, Joseph
  • Michelena, Hector I
  • Jain, Sonia
  • Badano, Luigi Paolo
  • Enriquez-Sarano, Maurice
subjects:
  • Abridged Index Medicus
  • Aged
  • Cardiovascular disease
  • Care and treatment
  • Catheters
  • Clinical medicine
  • Datasets
  • Diagnosis
  • Echocardiography, Doppler
  • Echocardiography, Three-Dimensional
  • Echocardiography, Transesophageal
  • Female
  • Hemodynamics
  • Humans
  • Image Interpretation, Computer-Assisted
  • Male
  • Middle Aged
  • Mitral Valve - diagnostic imaging
  • Mitral Valve - physiopathology
  • Mitral Valve - surgery
  • Mitral valve insufficiency
  • Mitral Valve Insufficiency - diagnostic imaging
  • Mitral Valve Insufficiency - physiopathology
  • Mitral Valve Insufficiency - surgery
  • Mitral Valve Prolapse - diagnostic imaging
  • Mitral Valve Prolapse - physiopathology
  • Mitral Valve Prolapse - surgery
  • Mitral valve repair
  • Morphology
  • Predictive Value of Tests
  • Prospective Studies
  • Quantitative analysis
  • Severity of Illness Index
  • Software
  • Surgery
  • Transesophageal echocardiography
  • Treatment Outcome
  • Usage
  • Ventricular Function, Left
ispartof: Heart (British Cardiac Society), 2015-07, Vol.101 (14), p.1111-1117
description: ObjectivesCleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing diagnostic accuracy and defining mechanisms of CLI in patients undergoing surgery for MMVD.Methods3DTOC of mitral valve was acquired in 49 patients with MMVD and severe regurgitation prior to valve repair. Qualitative review compared 3DTOC diagnosis of CLI with surgical inspection. Mitral, annular and leaflet dimensions were quantified with dedicated software and compared between those with and without CLI.ResultsDiagnosis of CLI was made by 3DTOC in 17 (35%) while none was identified by 2D and was confirmed in 15 (88%) by surgical inspection. Mechanistically, LV diameters and mitral regurgitant volume (RVol) were similar with and without CLI (p>0.49). Conversely, mitral annulus was smaller with CLI (anteroposterior diameter 42.2±7.1 vs 47.0±7.5 mm, p=0.04; circumference 133±16 vs 148±19 mm, p=0.009; area 1289±326 vs 1619±427 mm2, p=0.008). Prolapse volume tended to be smaller with CLI (1.9±1.2 vs 4.0±4.3 mL, p=0.06) involving single posterior scallop at surgery (82% vs 44%, p=0.007) with smaller 3DTOC leaflet area (1574±409 vs 2019±652 mm2, p=0.01). During valve repair, surgical closure of all surgically diagnosed CLI was required.ConclusionsPosterior leaflet CLI are frequent in MMVD, are identified by 3DTOC with high accuracy and require closure during valve repair. CLI are mechanistically not related to excess annular enlargement or excess prolapse. Conversely, CLI occur in the context of single scallop prolapse with tissue paucity causing excess separation of scallops. These 3DTOC data enhance diagnostic and mechanistic comprehension of the diversity of MMVD phenotypical presentation.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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titleCleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging
sourceAlma/SFX Local Collection
creatorMantovani, Francesca ; Clavel, Marie-Annick ; Vatury, Ori ; Suri, Rakesh M ; Mankad, Sunil V ; Malouf, Joseph ; Michelena, Hector I ; Jain, Sonia ; Badano, Luigi Paolo ; Enriquez-Sarano, Maurice
creatorcontribMantovani, Francesca ; Clavel, Marie-Annick ; Vatury, Ori ; Suri, Rakesh M ; Mankad, Sunil V ; Malouf, Joseph ; Michelena, Hector I ; Jain, Sonia ; Badano, Luigi Paolo ; Enriquez-Sarano, Maurice
descriptionObjectivesCleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing diagnostic accuracy and defining mechanisms of CLI in patients undergoing surgery for MMVD.Methods3DTOC of mitral valve was acquired in 49 patients with MMVD and severe regurgitation prior to valve repair. Qualitative review compared 3DTOC diagnosis of CLI with surgical inspection. Mitral, annular and leaflet dimensions were quantified with dedicated software and compared between those with and without CLI.ResultsDiagnosis of CLI was made by 3DTOC in 17 (35%) while none was identified by 2D and was confirmed in 15 (88%) by surgical inspection. Mechanistically, LV diameters and mitral regurgitant volume (RVol) were similar with and without CLI (p>0.49). Conversely, mitral annulus was smaller with CLI (anteroposterior diameter 42.2±7.1 vs 47.0±7.5 mm, p=0.04; circumference 133±16 vs 148±19 mm, p=0.009; area 1289±326 vs 1619±427 mm2, p=0.008). Prolapse volume tended to be smaller with CLI (1.9±1.2 vs 4.0±4.3 mL, p=0.06) involving single posterior scallop at surgery (82% vs 44%, p=0.007) with smaller 3DTOC leaflet area (1574±409 vs 2019±652 mm2, p=0.01). During valve repair, surgical closure of all surgically diagnosed CLI was required.ConclusionsPosterior leaflet CLI are frequent in MMVD, are identified by 3DTOC with high accuracy and require closure during valve repair. CLI are mechanistically not related to excess annular enlargement or excess prolapse. Conversely, CLI occur in the context of single scallop prolapse with tissue paucity causing excess separation of scallops. These 3DTOC data enhance diagnostic and mechanistic comprehension of the diversity of MMVD phenotypical presentation.
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languageeng
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subjectAbridged Index Medicus ; Aged ; Cardiovascular disease ; Care and treatment ; Catheters ; Clinical medicine ; Datasets ; Diagnosis ; Echocardiography, Doppler ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Female ; Hemodynamics ; Humans ; Image Interpretation, Computer-Assisted ; Male ; Middle Aged ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Mitral valve insufficiency ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Mitral Valve Prolapse - diagnostic imaging ; Mitral Valve Prolapse - physiopathology ; Mitral Valve Prolapse - surgery ; Mitral valve repair ; Morphology ; Predictive Value of Tests ; Prospective Studies ; Quantitative analysis ; Severity of Illness Index ; Software ; Surgery ; Transesophageal echocardiography ; Treatment Outcome ; Usage ; Ventricular Function, Left
ispartofHeart (British Cardiac Society), 2015-07, Vol.101 (14), p.1111-1117
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0Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
1Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
2Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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0Mantovani, Francesca
1Clavel, Marie-Annick
2Vatury, Ori
3Suri, Rakesh M
4Mankad, Sunil V
5Malouf, Joseph
6Michelena, Hector I
7Jain, Sonia
8Badano, Luigi Paolo
9Enriquez-Sarano, Maurice
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descriptionObjectivesCleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing diagnostic accuracy and defining mechanisms of CLI in patients undergoing surgery for MMVD.Methods3DTOC of mitral valve was acquired in 49 patients with MMVD and severe regurgitation prior to valve repair. Qualitative review compared 3DTOC diagnosis of CLI with surgical inspection. Mitral, annular and leaflet dimensions were quantified with dedicated software and compared between those with and without CLI.ResultsDiagnosis of CLI was made by 3DTOC in 17 (35%) while none was identified by 2D and was confirmed in 15 (88%) by surgical inspection. Mechanistically, LV diameters and mitral regurgitant volume (RVol) were similar with and without CLI (p>0.49). Conversely, mitral annulus was smaller with CLI (anteroposterior diameter 42.2±7.1 vs 47.0±7.5 mm, p=0.04; circumference 133±16 vs 148±19 mm, p=0.009; area 1289±326 vs 1619±427 mm2, p=0.008). Prolapse volume tended to be smaller with CLI (1.9±1.2 vs 4.0±4.3 mL, p=0.06) involving single posterior scallop at surgery (82% vs 44%, p=0.007) with smaller 3DTOC leaflet area (1574±409 vs 2019±652 mm2, p=0.01). During valve repair, surgical closure of all surgically diagnosed CLI was required.ConclusionsPosterior leaflet CLI are frequent in MMVD, are identified by 3DTOC with high accuracy and require closure during valve repair. CLI are mechanistically not related to excess annular enlargement or excess prolapse. Conversely, CLI occur in the context of single scallop prolapse with tissue paucity causing excess separation of scallops. These 3DTOC data enhance diagnostic and mechanistic comprehension of the diversity of MMVD phenotypical presentation.
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10Echocardiography, Transesophageal
11Female
12Hemodynamics
13Humans
14Image Interpretation, Computer-Assisted
15Male
16Middle Aged
17Mitral Valve - diagnostic imaging
18Mitral Valve - physiopathology
19Mitral Valve - surgery
20Mitral valve insufficiency
21Mitral Valve Insufficiency - diagnostic imaging
22Mitral Valve Insufficiency - physiopathology
23Mitral Valve Insufficiency - surgery
24Mitral Valve Prolapse - diagnostic imaging
25Mitral Valve Prolapse - physiopathology
26Mitral Valve Prolapse - surgery
27Mitral valve repair
28Morphology
29Predictive Value of Tests
30Prospective Studies
31Quantitative analysis
32Severity of Illness Index
33Software
34Surgery
35Transesophageal echocardiography
36Treatment Outcome
37Usage
38Ventricular Function, Left
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titleCleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging
authorMantovani, Francesca ; Clavel, Marie-Annick ; Vatury, Ori ; Suri, Rakesh M ; Mankad, Sunil V ; Malouf, Joseph ; Michelena, Hector I ; Jain, Sonia ; Badano, Luigi Paolo ; Enriquez-Sarano, Maurice
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1Aged
2Cardiovascular disease
3Care and treatment
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5Clinical medicine
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8Echocardiography, Doppler
9Echocardiography, Three-Dimensional
10Echocardiography, Transesophageal
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12Hemodynamics
13Humans
14Image Interpretation, Computer-Assisted
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16Middle Aged
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18Mitral Valve - physiopathology
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20Mitral valve insufficiency
21Mitral Valve Insufficiency - diagnostic imaging
22Mitral Valve Insufficiency - physiopathology
23Mitral Valve Insufficiency - surgery
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0Mantovani, Francesca
1Clavel, Marie-Annick
2Vatury, Ori
3Suri, Rakesh M
4Mankad, Sunil V
5Malouf, Joseph
6Michelena, Hector I
7Jain, Sonia
8Badano, Luigi Paolo
9Enriquez-Sarano, Maurice
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abstractObjectivesCleft-like indentations (CLI) are deep separations between scallops of the mitral posterior leaflet observed in myxomatous mitral valve disease (MMVD), but their diagnosis, mechanisms and implications are unknown. Using 3D transoesophageal echocardiography (3DTOC), we aimed at assessing diagnostic accuracy and defining mechanisms of CLI in patients undergoing surgery for MMVD.Methods3DTOC of mitral valve was acquired in 49 patients with MMVD and severe regurgitation prior to valve repair. Qualitative review compared 3DTOC diagnosis of CLI with surgical inspection. Mitral, annular and leaflet dimensions were quantified with dedicated software and compared between those with and without CLI.ResultsDiagnosis of CLI was made by 3DTOC in 17 (35%) while none was identified by 2D and was confirmed in 15 (88%) by surgical inspection. Mechanistically, LV diameters and mitral regurgitant volume (RVol) were similar with and without CLI (p>0.49). Conversely, mitral annulus was smaller with CLI (anteroposterior diameter 42.2±7.1 vs 47.0±7.5 mm, p=0.04; circumference 133±16 vs 148±19 mm, p=0.009; area 1289±326 vs 1619±427 mm2, p=0.008). Prolapse volume tended to be smaller with CLI (1.9±1.2 vs 4.0±4.3 mL, p=0.06) involving single posterior scallop at surgery (82% vs 44%, p=0.007) with smaller 3DTOC leaflet area (1574±409 vs 2019±652 mm2, p=0.01). During valve repair, surgical closure of all surgically diagnosed CLI was required.ConclusionsPosterior leaflet CLI are frequent in MMVD, are identified by 3DTOC with high accuracy and require closure during valve repair. CLI are mechanistically not related to excess annular enlargement or excess prolapse. Conversely, CLI occur in the context of single scallop prolapse with tissue paucity causing excess separation of scallops. These 3DTOC data enhance diagnostic and mechanistic comprehension of the diversity of MMVD phenotypical presentation.
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