Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy

Abstract

The mitral valve apparatus is a complex structure consisting of several coordinating components: the annulus, two leaflets, the chordae tendineae, and the papillary muscles. Due to the intricate interplay between the mitral valve and the left ventricle, a disease of the latter may influence the normal function of the former. As a consequence, valve insufficiency may arise despite the absence of organic valve disease. This is designated as functional or secondary mitral regurgitation, and it arises from a series of distortions to the valve components. This narrative review describes the normal anatomy and the pathophysiology behind the mitral valve changes in ischemic and non-ischemic dilated cardiomyopathies. It also explains the value of a complete multiparametric assessment of this structure. Not only must an assessment include quantitative measures of regurgitation, but also various anatomical parameters from the mitral apparatus and left ventricle, since they carry prognostic value and are predictors of mitral valve repair success and durability.

Keywords: Mitral valve; dilated cardiomyopathy; ischemic cardiomyopathy; mitral valve insufficiency; myocardial infarction; non-ischemic cardiomyopathy; secondary mitral regurgitation.

Figure 1.

Echocardiograph images showing examples of functional mitral regurgitation: (a) central mitral regurgitation; and (b) eccentric mitral regurgitation in the setting of anterior leaflet pseudo prolapse.

Figure 2.

Echocardiograph images showing mitral valve displacement measurements: (a) tenting height; (b) coaptation reserve; and (c) tenting area.