Quantitative mitral valve anatomy and pathology

Abstract

Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications.

Keywords: 3D; echocardiography; mitral valve; morphology; quantification; repair.

Figure 1

Papillary muscle to annulus plane (red continuous line) distances (red dotted lines).

Figure 2

Normal annulus saddle shape. A, anterior; P, posterior; Ao, aortic valve; PM, postero-medial; AL, antero-lateral.

Figure 3

Normal annulus saddle and relative position of the papillary muscle tips. A, anterior; P, posterior; Ao, aortic valve; PM, postero-medial; AL, antero-lateral.

Figure 4

Predominant P2 prolapse.

Figure 5

Lone P2 prolapse.

Figure 6

3D model of the valve in Fig. 5 (lone P2 prolapse). A, anterior; P, posterior; Ao, aortic valve; PM, postero-medial; AL, antero-lateral.

Figure 7

3D model of the valve in Fig. 4 (predominant P2 but also more extensive prolapse of the posterior leaflet and commissures). A, anterior; P, posterior; Ao, aortic valve; PM, postero-medial; AL, antero-lateral.

Figure 8

3D model of Barlow valve with extensive prolapse.

Figure 9

The 3D model from Fig. 8 displayed to reveal leaflet atrialisation.

Figure 10

TOE 2D images (MPR) derived from the 3D dataset at Fig. 5 demonstrating single scallop prolapse and otherwise thin, normal leaflets not billowing above the annulus plane (red dotted line).

Figure 11

TOE 2D images (MPR) derived from the 3D dataset of the valve from Fig. 8 for an alternative demonstration of leaflet atrialisation, with extensive billowing above the annulus plane (red dotted line).

Figure 12

Tenting area.

Figure 13

Tethering angles in valve with bent anterior leaflet. Red dotted lines define the annulus plane and the plane of the proximal anterior leaflet, and red continuous lines define the distal anterior leaflet and the posterior leaflet.