Revealing Mitral Valve Cleft Using Real-Time 3-Dimensional Echocardiography in Children with Mitral Regurgitation

Abstract

Mitral valve cleft (MVC) is the most common cause of congenital mitral regurgitation (MR). MVC may be located on the anterior or posterior leaflets. We evaluated children with moderate-to-severe MR using 3D transthoracic echocardiography (3DTTE) to diagnose MVC and determine the location, shape and size of MVC. Twenty-one patients under 18 years of age with moderate-to-severe MR without symptoms who were suspected of having MVC were included in the study. The patients' history and clinical data were obtained from the medical records. 2D and 3D imaging were performed with a high-quality machine (EPIQ CVx). A vena contracta (VC) of colour Doppler regurgitated jet 3-7 and ≥ 7 mm defined moderate-to-severe regurgitation. An isolated anterior leaflet cleft (ALC) was detected in four patients, an isolated posterior leaflet cleft (PLC) in 12 patients, and both an ALC and PLC in five patients. VC was larger in patients with ALCs than PLCs (8.85 mm vs. 6.64 mm). Global LV longitudinal strain was better in the ALC group than in the PLC and both-posterior-and anterior MVC groups (- 24.7, - 24.3, and - 24%, respectively). Global circumferential strain was better in the ALC group (- 28.9%) and reduced in the bi-leaflet MVC group (- 28.6%). 3DTTE for visualisation of the MV can be successfully implemented in children and should be proposed during follow-up. AMVC and bi-leaflet MVC results in severe regurgitation and bi-leaflet MVC may be the reason for systolic dysfunction determined before clinically proven symptoms in the future.

Keywords: 3D echocardiography; Mitral regurgitation; Mitral valve cleft.