Page 101 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Figure 2. Example of mitral valve angle quantification on echocardiography.
The white dashed line represents the mitral valve annular plane. The red dashed line represents the line from the mitral valve annulus to the bending point of the anterior mitral leaflet, defining the basal mitral anterior leaflet angle (ALAbase). The yellow dashed line represents the line from the mitral valve annulus to the tip of the anterior mitral leaflet, defining the distal mitral anterior leaflet angle (ALAdist). The green dashed line represents the line from the mitral valve annulus to the tip of the posterior mitral leaflet, defining the posterior mitral leaflet angle (PLA).
Results
Baseline clinical characteristics have been previously reported (13) and are summarized in Supplemental Appendix Table 1. The echocardiographic characteristics including the mitral valve geometry analysis are outlined in Table 2. The mean intercommissural (3.56 ± 0.43 cm) and anteroposterior (3.26 ± 0.39 cm) mitral annulus diameters were comparable demonstrating a circular rather than an elliptical shape of the mitral annulus. Significant tethering of the mitral valve leaflets was observed as indicated by the large distance between the point of coaptation and the interventricular septum, the increased tenting height/area and the increased posterior leaflet angle. Leaflet tethering was most frequently observed at the central level of the posterior mitral leaflet (P2). Intraobserver reproducibility of all the mitral valve echocardiographic measurements was tested in a randomly selected sample of 20 cases. Agreement was very good or excellent for all mitral valve measurements (intraclass coefficient [ICC] >0.7), except for the length of the anterior and posterior mitral valve leaflets (ICC 0.5; 95% CI 0.24 to 0.78 and ICC 0.57; 95% CI 0.15 to 0.74, respectively), and the anterior papillary muscle to mitral valve annulus distance (ICC 0.26; 95% CI -0.14 to 0.58). As previously described, patients had severe MR with a mean effective regurgitant orifice
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