Usefulness of 3-Tesla Cardiac Magnetic Resonance to Detect Mitral Annular Disjunction in Patients With Mitral Valve Prolapse
Benjamin EssayaghLaura IacuzioFilippo CivaiaJean‐François AvierinosChristophe TribouilloyFranck Lévy
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Mitral valve prolapse
Papillary muscle
Mitral annulus
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Mitral annulus
Mitral valve prolapse
Abnormality
Annulus (botany)
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In patients with ischemic left ventricular dysfunction and functional mitral regurgitation, the surgical treatment of the mitral insufficiency remains a challenging issue. Several procedures were described to restore a more normal alignment between the mitral annulus and the laterally displaced papillary muscles. We report a new approach to relocate the displaced papillary toward the mitral annulus and to reduce tethering. This procedure is believed to be technically easy and beneficial in terms of mitral repair.
Mitral annulus
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Annulus (botany)
Functional mitral regurgitation
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Mitral annulus calcification is a common incidental finding in echocardiography examination of predisposed populations. On the other hand, caseous calcification of the mitral annulus is a rare variant that challenges the physician to differentiate it from different causes of cardiac masses. We describe a case of incidentally discovered caseous calcification confirmed with CT cardiac and cardiac magnetic resonance.Caseous calcification of the mitral annulus is a rare condition.An important differential diagnosis is cardiac tumours and myocardial abscesses.Cardiac computed tomography and cardiac magnetic resonance imaging are important in confirming the diagnosis, and assessing the extent and location of annular calcium.
Mitral annulus
Cardiac magnetic resonance
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Mitral valve prolapse
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Abstract: Ischemic mitral prolapse (IMP) is a pathologic entity encountered in about one-third among the patients undergoing surgery for ischemic mitral regurgitation (IMR). IMP is generally the result of a papillary muscle injury consequent to myocardial, but the recent literature is progressively unveiling a more complex pathogenesis. The mechanisms underlying its development regards the impairment of one or more components of the mitral apparatus, which comprises the annulus, the chordae tendineae, the papillary muscle and the left ventricular wall. IMP is not only a disorder of valvular function, but also entails coexistent aspects of a geometric disturbance of the mitral valve configuration and of the left ventricular function and dimension and a correct understanding of all these aspects is crucial to guide and tailor the correct therapeutic strategy to be adopted. Localization of prolapse, anatomic features of the prolapsed leaflets and the subvalvular apparatus should be carefully evaluated as also constituting the major determinants defining patient’s outcomes. This review will summarize our current understanding of the pathophysiology and clinical evidence on IMP with a particular focus on the surgical treatment.
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Objective: 3D printed models have been demonstrated to be useful in therapeutic guiding. We attempted to assess the inadequately understood mitral valve annulus (MA) and papillary muscle (PM) geometrical changes in diastolic and systolic hearts performed mitral valve plasty (MVP) using 3D printed left ventricular models. Methods: The pre- and postoperative MVP models in end-diastolic (ED) and end-systolic (ES) in three mitral valve prolapse cases, total twelve 3D printed models were created in order to analyze the geometry. Results: Characterizing the shape of the annulus, in preoperative models, shorter annular diameter (AD) was not remarkably changed from ED to ES (26.5 to 26.0mm), whereas longer AD was decreased (38.1 to 35.8mm). Eccentricity (measure of how circular a shape is) increased from ED to ES (0.70 to 0.73) showing that the annulus became more circular form in ES. In postoperative models, both AD and eccentricity were not significantly changed through the cardiac cycle because of using physio ring. Interpapillary muscle distance (IPMD) was measured from papillary tip-to-tip and base-to-base. In preoperative models, tip-to-tip and base-to-base IPMD decreased from ED to ES respectively (25.9 to 17.0, 28.1 to 20.5). Similarly, in postoperative models, both IPMD decreased from ED to ES (24.9 to 19.0, 33.1 to 21.0). On the other hand, the position of tip-to-tip IPMD were not remarkably changed between pre- and postoperatively, however base-to-base IPMD were dilated. Pre- and postoperative distance from PM tip to the apex decreased from ED to ES, suggesting a papillary muscle apical movement (50.4 to 64.3mm, 55.7 to 62.9mm). Papillary muscle apical movement in postoperative models were less than in preoperative models. Conclusions: The mitral valve annulus and papillary muscle geometry were remarkably changed between diastole and systole. Only the position of papillary muscle tip was not changed through mitral valve operation.
Papillary muscle
Mitral annulus
Annulus (botany)
Eccentricity (behavior)
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Mitral valve prolapse
Mitral annulus
Abnormality
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Contradiction exists on the incremental value of two-dimensional (2D) and 3D transoesophageal echocardiography (TOE) over 2D transthoracic echocardiography (TTE) for the detection of mitral valve (MV) prolapse in readers with different echocardiographic experience. Twenty patients and five healthy persons were retrospectively identified who had undergone 2D-TTE, 2D-TOE and 3D-TOE. Fifteen (75 %) patients had surgical evidence of prolapse of the posterior MV leaflet and five patients (25 %) had a dilated MV annulus without prolapse. Three reader groups with different echocardiographic expertise (novice, trainees, cardiologists) scored thus in total 675 posterior scallops. Overall there was an improvement in agreement and Kappa values from novice to trainees to cardiologists. Diagnostic accuracies of 2D-TOE were higher than those of 2D-TTE mainly in novice readers. The incremental value of 3D-TOE over 2D-TOE was mainly seen in specificities. Time to diagnosis was dramatically reduced from 2D to 3D-TEE in all reader groups (all P < 0.001). 3D-TOE also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTE analysis. 3D-TOE analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent.
Mitral valve prolapse
Mitral annulus
Kappa
Cardiac Imaging
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Mitral valve prolapse
Mitral annulus
Parasternal line
Chordae tendineae
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Patients with heritable aortic disease (HAD) have an increased risk of ventricular arrhythmias and sudden cardiac death. Although mitral valve prolapse is common in HAD, mitral annulus disjunction (MAD) has only recently been described in these patients. This under-recognized condition may be a contributing factor to otherwise unexplained ventricular arrhythmias and sudden cardiac death in patients with HAD. This case series describes 3 patients in an adult HAD clinic who have concomitant mitral valve prolapse, MAD, and malignant arrhythmias. These cases may represent a unique disease entity or overlap syndrome, and they introduce MAD as a potential arrhythmogenic risk marker in HAD.
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Annulus (botany)
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