Three-dimensional Echocardiography in Characterization of Degenerative Mitral Valve Disease

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Abstract

Background: Degenerative mitral valve regurgitation is a highly prevalent disease representing the most common cause of mitral
valve surgery, whose outcome is closely associated with the type of procedure. Three-dimensional (3D) transesophageal echocardiography allows assessing the complexity and extension of the degenerative process, thus optimizing the therapeutic strategy.
Objectives: The aim of this study was to assess the characteristics and dimensions of the mitral valve apparatus with 3D-transesophageal echocardiography to identify patients with different complexity and extension of the disease, and to compare these results with a population without heart disease.
Methods: Twenty-five patients with severe degenerative mitral valve regurgitation and 26 patients without cardiovascular disease
were prospectively included and studied with 2D-and 3D transesophageal echocardiography. A three-dimensional valve model was built with the best 3D sequence to obtain leaflet and annulus measurements (normalized by body surface area). The population with mitral regurgitation was divided into two groups: group A consisting of 17 patients with prolapse in only one segment was compared with Group B including 8 patients with more than one prolapsed segment. Then, mitral annulus morphology and dimensions of
patients with mitral regurgitation were compared with the population without heart disease. Data are presented as median and intequartile range. The Wilcoxon test was used to compare groups. A two-tailed p value <0.05 was considered statistically significant.
Results: Seventy-six percent of patients with mitral regurgitation were men, with average age 60.6 (53-73.2) years. Group B patients presented left ventricular end-diastolic diameter and mitral annulus with significantly enlarged area, circumference and intercommissural diameter. Anterior valve area and prolapse volume were significantly larger in group B. No differences in mitral valve annulus morphology were observed when patients with mitral regurgitation were compared with the group without heart disease.
Conclusions: In patients with severe degenerative mitral regurgitation, 3D-transesophageal echocardiography allows identifying
marked differences between populations with different extension of valvular involvement. The data thus obtained might have added
value when deciding the therapeutic conduct.