Magnetic Resonance Imaging Assessment of the Severity of Mitral Regurgitation
W. Gregory HundleyHong F. LiJohn E. WillardCharles LandauRichard A. LangeBenjamin M. MeshackL. David HillisRonald M. Peshock
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Abstract:
Background In the patient with mitral regurgitation who is being considered for valvular surgery, cardiac catheterization is usually performed to quantify the severity of regurgitation and to determine its influence on left ventricular volumes and systolic function. Magnetic resonance imaging (MRI) potentially provides a rapid, noninvasive method of acquiring these data. Thus, this study was done to determine whether MRI can reliably measure the magnitude of mitral regurgitation and evaluate the effect of regurgitation on left ventricular volumes and systolic function. Methods and Results Twenty-three subjects (14 women and 9 men 15 to 72 years of age) with (n=17) or without (n=6) mitral regurgitation underwent MRI scanning followed immediately by cardiac catheterization. The presence (or absence) of valvular regurgitation was determined, and left ventricular volumes and regurgitant fraction were quantified during each procedure. There was excellent correlation between invasive and MRI assessments of left ventricular end-diastolic ( r =.95) and end-systolic ( r =.95) volumes and regurgitant fraction ( r =.96). All MRI examinations were completed in <28 minutes. Conclusions In the patient with mitral regurgitation, MRI compares favorably with cardiac catheterization for assessment of the magnitude of regurgitation and its influence on left ventricular volumes and systolic function.Keywords:
Functional mitral regurgitation
Cardiac magnetic resonance
Degenerative mitral valve prolapse without proper monitoring can cause severe mitral valve failure and occasionally lead to sudden death if the surgical correction is not performed on time. In most cases, mitral valve prolapse would cause mitral regurgitation which in a severe case would lead to left ventricle failure due to hemodynamic burden. The aim of this study is to develop a model to predict the degeneration behaviour of mitral valve which will aid the medical practitioner to estimate the mitral valve condition based on the available mitral regurgitation data by echocardiogram assessment. Minimal hemodynamic model has been adopted with modification to obtain mitral regurgitation severity information. The stress-strain behaviour of mitral leaflet has also been studied to model the degeneration of the mitral valve leaflet. Both models were validated with the previously published data generated using Windkessel and Burkhoff methods. The coupling of both models gave the degenerative behaviour of mitral valve leaflet in relation with mitral regurgitation severity. The mitral valve degeneration was assessed by mitral valve leaflet elasticity properties while the severity of mitral regurgitation was measured by the volume of mitral regurgitation into the left atrium. It was found that the reduction of mitral valve leaflet elasticity would cause an increase of the mitral regurgitation volume into the left atrium. Mitral regurgitation severity was found to be less than 10% of left ventricle stroke volume when the mitral valve leaflet degenerates more than 90%. At this point, even with a slight increase of less than 10% in the degeneration of mitral valve leaflet, the regurgitation volume might increase suddenly from 5% up to 95% of the left ventricle stroke volume.
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Degenerative mitral valve prolapse without proper monitoring can cause severe mitral valve failure and occasionally lead to sudden death if the surgical correction is not performed on time. In most cases, mitral valve prolapse would cause mitral regurgitation which in a severe case would lead to left ventricle failure due to hemodynamic burden. The aim of this study is to develop a model to predict the degeneration behaviour of mitral valve which will aid the medical practitioner to estimate the mitral valve condition based on the available mitral regurgitation data by echocardiogram assessment. Minimal hemodynamic model has been adopted with modification to obtain mitral regurgitation severity information. The stress-strain behaviour of mitral leaflet has also been studied to model the degeneration of the mitral valve leaflet. Both models were validated with the previously published data generated using Windkessel and Burkhoff methods. The coupling of both models gave the degenerative behaviour of mitral valve leaflet in relation with mitral regurgitation severity. The mitral valve degeneration was assessed by mitral valve leaflet elasticity properties while the severity of mitral regurgitation was measured by the volume of mitral regurgitation into the left atrium. It was found that the reduction of mitral valve leaflet elasticity would cause an increase of the mitral regurgitation volume into the left atrium. Mitral regurgitation severity was found to be less than 10% of left ventricle stroke volume when the mitral valve leaflet degenerates more than 90%. At this point, even with a slight increase of less than 10% in the degeneration of mitral valve leaflet, the regurgitation volume might increase suddenly from 5% up to 95% of the left ventricle stroke volume.
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A quantitative assessment of mitral valve orifice area can be achieved in patients with pure mitral stenosis by cardiac catheterization. In the presence of mitral regurgitation, however, accurate measurement often is impossible because total diastolic flow through the mitral valve frequently is unknow. Using a recently developed real-time, two-dimensional echocardiography system, we are able to obtain cross-sectional images of the mitral valve by scanning the heart perpendicular to its long axis at the level of the tip of the mitral leaflets. Twenty consecutive patients undergoing operation for mitral valve disease were studied during the week prior to operation. In 18 of 20 (90%) the mitral orifice was imaged successfully in early diastole by two-dimensional echocardiography so that mitral valve orifice area could be measured directly in square centimeters. In 14 patients (ten with associated mitral regurgitation), mitral orifice area was measured both by echocardiography and directly at time of operation. In 12 of 14 (86%) patients, mitral orifice area by two-dimensional echocardiography was within 0.3 square centimeters of that measured at operation (correlation coefficient for all 14 patients equals 0.92). We conclude that two-dimensional echocardiography is extremely useful in the evaluation of patients with mitral valve disease because it provides a noninvasive method for directly measuring the mitral valve orifice area that is accurate even in the presence of mitral regurgitation.
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Degenerative mitral valve prolapse without proper monitoring can cause severe mitral valve failure and occasionally lead to sudden death if the surgical correction is not performed on time. In most cases, mitral valve prolapse would cause mitral regurgitation which in a severe case would lead to left ventricle failure due to hemodynamic burden. The aim of this study is to develop a model to predict the degeneration behaviour of mitral valve which will aid the medical practitioner to estimate the mitral valve condition based on the available mitral regurgitation data by echocardiogram assessment. Minimal hemodynamic model has been adopted with modification to obtain mitral regurgitation severity information. The stress-strain behaviour of mitral leaflet has also been studied to model the degeneration of the mitral valve leaflet. Both models were validated with the previously published data generated using Windkessel and Burkhoff methods. The coupling of both models gave the degenerative behaviour of mitral valve leaflet in relation with mitral regurgitation severity. The mitral valve degeneration was assessed by mitral valve leaflet elasticity properties while the severity of mitral regurgitation was measured by the volume of mitral regurgitation into the left atrium. It was found that the reduction of mitral valve leaflet elasticity would cause an increase of the mitral regurgitation volume into the left atrium. Mitral regurgitation severity was found to be less than 10% of left ventricle stroke volume when the mitral valve leaflet degenerates more than 90%. At this point, even with a slight increase of less than 10% in the degeneration of mitral valve leaflet, the regurgitation volume might increase suddenly from 5% up to 95% of the left ventricle stroke volume.
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