Kikuko Obase1, Lynn Weinert2, Andrew Hollatz3, Farhan Farooqui3, Joseph D Roberts3, Mohammed M Minhaj3, Avery Tung3, Mark Chaney3, Takeyoshi Ota4, Valluvan Jeevanandam4, Kiyoshi Yoshida5, Victor Mor-Avi2, Roberto M Lang6. 1. Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637, USA Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. 2. Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637, USA. 3. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA. 4. Cardiovascular Surgery, University of Chicago, Chicago, IL, USA. 5. Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. 6. Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637, USA rlang@medicine.bsd.uchicago.edu.
Abstract
AIMS: In functional mitral regurgitation (FMR), increased leaflet area has been described as a remodelling compensatory mechanism. We hypothesized that chordae tendineae elongation would also occur as part of this remodelling. In this study, the lengths of primary chords and measurements of mitral leaflets and annulus were compared with varying degrees of mitral regurgitation (MR). METHODS AND RESULTS: We studied 58 patients who underwent three-dimensional (3D) transoesophageal echocardiography, including 38 with FMR and 20 with normal mitral valves (NL). The FMR group was divided into two subgroups according to two-dimensional vena contracta width (VCW). Three-dimensional datasets from transgastric or mid-oesophageal approach were used to measure primary chordal length, coaptation length, inter-papillary muscle distances, and quantitative 3D measurements of the annulus and leaflets. Leaflet surface area was increased and coaptation length was decreased in FMR compared with NL. While no difference in other 3D measurement of annulus/leaflets was noted between the FMR subgroups, averaged chordal length was shorter in patients with more severe FMR. Chords of the anterior leaflet in FMR with larger VCW were shorter compared with both NL and FMR with smaller VCW. In contrast, the chords of the posterior leaflet were longer in FMR with smaller VCW compared with the other two groups. CONCLUSION: Our results suggest the posterior leaflet chords possibly remodel by elongating and contribute to reduced MR and that in a subgroup of FMR patients, the primary chords may remodel by shortening, resulting in augmented MR. This information could be useful in choosing strategy for FMR correction. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: In functional mitral regurgitation (FMR), increased leaflet area has been described as a remodelling compensatory mechanism. We hypothesized that chordae tendineae elongation would also occur as part of this remodelling. In this study, the lengths of primary chords and measurements of mitral leaflets and annulus were compared with varying degrees of mitral regurgitation (MR). METHODS AND RESULTS: We studied 58 patients who underwent three-dimensional (3D) transoesophageal echocardiography, including 38 with FMR and 20 with normal mitral valves (NL). The FMR group was divided into two subgroups according to two-dimensional vena contracta width (VCW). Three-dimensional datasets from transgastric or mid-oesophageal approach were used to measure primary chordal length, coaptation length, inter-papillary muscle distances, and quantitative 3D measurements of the annulus and leaflets. Leaflet surface area was increased and coaptation length was decreased in FMR compared with NL. While no difference in other 3D measurement of annulus/leaflets was noted between the FMR subgroups, averaged chordal length was shorter in patients with more severe FMR. Chords of the anterior leaflet in FMR with larger VCW were shorter compared with both NL and FMR with smaller VCW. In contrast, the chords of the posterior leaflet were longer in FMR with smaller VCW compared with the other two groups. CONCLUSION: Our results suggest the posterior leaflet chords possibly remodel by elongating and contribute to reduced MR and that in a subgroup of FMR patients, the primary chords may remodel by shortening, resulting in augmented MR. This information could be useful in choosing strategy for FMR correction. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jacob P Dal-Bianco; Philipp E Bartko; Jonathan Beaudoin; Elena Aikawa; Joyce Bischoff; Robert A Levine Journal: Eur Heart J Cardiovasc Imaging Date: 2016-03-13 Impact factor: 6.875
Authors: Sjoerd Bouwmeester; Thomas P Mast; Daniëlle C J Keulards; Anouk G W de Lepper; Ingeborg H F Herold; Lukas R Dekker; Frits W Prinzen; Patrick Houthuizen Journal: J Echocardiogr Date: 2021-11-25
Authors: Philipp E Bartko; Jacob P Dal-Bianco; J Luis Guerrero; Jonathan Beaudoin; Catherine Szymanski; Dae-Hee Kim; Margo M Seybolt; Mark D Handschumacher; Suzanne Sullivan; Michael L Garcia; James S Titus; Jill Wylie-Sears; Whitney S Irvin; Emmanuel Messas; Albert A Hagège; Alain Carpentier; Elena Aikawa; Joyce Bischoff; Robert A Levine Journal: J Am Coll Cardiol Date: 2017-09-05 Impact factor: 24.094