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, 70 (3), 195-201

Mitral Leaflet Separation Index. An Easy Two Dimensional Echocardiography Technique for Assessment of Mitral Valve Area Before and After Percutaneous Balloon Mitral Valvuloplasty

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Mitral Leaflet Separation Index. An Easy Two Dimensional Echocardiography Technique for Assessment of Mitral Valve Area Before and After Percutaneous Balloon Mitral Valvuloplasty

Sameh S Raafat et al. Egypt Heart J.

Abstract

Aim: To evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV).

Methods: Ninety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views.

Results: MVA increased from 0.95 ± 0.28 to 2.21 ± 0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ± 0.23 to 2.21 ± 0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively.

Conclusion: The MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.

Keywords: Balloon mitral vavlvuloplasty; Mitral stenosis; Mitral valve; Rheumatic heart disease.

Figures

Fig. 1
Fig. 1
MVA by 2D planimetry echocardiography pre PBMV from a patient included in our study number 79.
Fig. 2
Fig. 2
MVA by PHT echocardiography pre PMBV from a patient included in our study number 17.
Fig. 3
Fig. 3
MLS measured in apical 4chamber view pre PBMV from patient number 48.
Fig. 4
Fig. 4
MLS measured in parasternal 2D echo pre PBM V from patient number 55.
Fig. 5
Fig. 5
MVA by 2D planimetry post PBMV from patient number 83.
Fig. 6
Fig. 6
MVA measured by PHT post PBMV from patient number 68.
Fig. 7
Fig. 7
MLS measured in parasternal view post PBMV from patient number 38.
Fig. 8
Fig. 8
MLS measured in 4chamber view post PBMV from patient number 19.
Fig. 9
Fig. 9
MVA pre PBMV using 2D planimetry.
Fig. 10
Fig. 10
MVA post PBMV using 2D planimetry.
Fig. 11
Fig. 11
Mitral regurgitation pre PBMV.
Fig. 12
Fig. 12
Mitral regurgitation post PBMV.
Fig. 13
Fig. 13
cutoff values of MLS index using 2d planimetry method.
Fig. 14
Fig. 14
cutoff values of MLS index using PHT.

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References

    1. WHO Technical Report, Series. Rheumatic fever and rheumatic heart disease: 1 November 2001. Geneva: WHO; 2004.
    1. Ntusi N.B., Mayosi B.M. Epidemiology of heart failure in sub-Saharan Africa. Expert Rev Cardiovasc Ther. 2009;7:169. - PubMed
    1. Bocchi E.A., Guimaraes G., Tarasoutshi F. Cardiomyopathy: adult valve disease and heart failure in South America. Heart. 2009;95:181. - PubMed
    1. Olson L.J., Subramanian R., Ackermann D.M. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987;62:22. - PubMed
    1. Horstkotte D., Niehues R., Strauer B.E. Pathomorphological aspects: aetiology and natural history of acquired mitral valve stenosis. Eur Heart J. 1991;12:55. - PubMed

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