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Ischemic mitral regurgitation (iMR) results from ventricular remodeling with annular dilatation and posterior leaflet tethering. Compensatory mitral valve (MV) changes that occur in response to iMR with inferior (iMI) versus anterior myocardial infarction (aMI) have been poorly characterized. We used 3D transthoracic echocardiographic (TTE) datasets to quantify differential MV remodeling in iMR due to iMI and aMI compared to Controls.
40 patients (14 iMI; 12 aMI; 14 controls) underwent MV 3D TTE. Dynamic and manual MV measurements were obtained using MV software (4D-MV, TomTec; QLAB, Philips). T-tests were used to compare groups.
Compared to controls, aMI patients have significantly larger, flatter, less spherical annuli due to increased anterolateral-posteromedial diameter (Table). They also have bileaflet enlargement with increased bileaflet thickness and an apically and posteriorly displaced coaptation point. In contrast, compared to controls iMI patients have significantly flatter and larger annuli. There is bileaflet increase in thickness but only significant enlargement of the posterior leaflet. When compared to iMI patients, aMI patients have less spherical annuli due to larger anterolateral-posteromedial diameters and a trend to smaller posterior leaflet thickness.
Differential MV remodeling in aMI and iMI patients has implications for surgical planning. Better understanding of the underlying adaptive pathophysiology is needed.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: Echo: Mitral Valve Imaging/RV Function
Abstract Category: 18. Imaging: Echo
Presentation Number: 1178-321
- 2013 American College of Cardiology Foundation