Three-dimensional remodeling of mitral valve in patients with significant regurgitation secondary to rheumatic versus prolapse etiology.

The present study aimed to investigate geometric remodeling of the mitral valve (MV) and to identify the geometric determinants of mitral regurgitation (MR) severity in patients with significant MR secondary to a rheumatic or prolapse etiology. We studied 90 consecutive patients in normal sinus rhythm, including 70 patients showing significant MR (52 with prolapsed/flail and 18 with rheumatic MV) and 20 controls with normal MV without MR. A full volume image was acquired using transesophageal echocardiography, and geometric analysis of the MV leaflet was performed with dedicated software. Areas of the MV annulus and the anterior and posterior leaflets were larger in the rheumatic and prolapsed MV than in the normal controls. No difference was found between the rheumatic and prolapsed MR in those parameters, except that the posterior leaflet area was smaller in rheumatic MR than in prolapsed MR. The leaflet to annulus area ratio was lower and the anterior to posterior leaflet area ratio was higher in the rheumatic MR group than in the prolapsed MR group. A large anteroposterior annulus diameter and small posterior leaflet tenting angle were independently associated with the effective regurgitant orifice area in rheumatic MV, although the leaflet to annulus area ratio was independently associated with the effective regurgitant orifice area in the prolapsed MV. In conclusion, similarities and differences in geometric MV remodeling exist between rheumatic and prolapsed MR. The knowledge of those quantitative differences could open the way to precise planning of surgery tailored to the underlying pathologic entity.