Page 14 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter one. General introduction and outline of thesis
and dysfunction or left atrial dilation but the mitral leaflets are structurally normal). The classification by Dr. Carpentier [2], considering the motion of the mitral valve leaflets, divides the mechanisms of mitral regurgitation into three different types: type I, when the mitral leaflets are structurally normal, the left ventricular systolic function is preserved and mitral annulus dilatation is the only mechanism responsible for mitral regurgitation; type II, when there is excessive motion of the mitral valve leaflets (causing prolapse); and type III, when there is restrictive motion of the mitral valve leaflets (IIIa, with systolic and diastolic restriction due to primary thickening of the mitral valve apparatus; IIIb, with systolic restriction due to tethering of the leaflets by dilation and severe dysfunction of the left ventricle). When there is primary damage of structurally normal leaflets, such as perforation because of endocarditis, the mechanism is also considered type I. Grading mitral regurgitation needs the integration of qualitative, semiquantitative, and quantitative echocardiographic parameters (Fig. 2). However, in very eccentric regurgitant jets or in patients with secondary mitral regurgitation, the criteria may be discordant and grading the severity of mitral regurgitation becomes challenging. In those situations, three-dimensional echocardiography or CMR may help to discern between severe and nonsevere mitral regurgitation.
Figure 1: Transcatheter mitral valve therapies. Mitral valve devices targeting the mitral valve leaflet (Panel a = MitraClip device, Abbott Vascular, Santa Clara, California (courtesy of Abbott Vascular); panel b = Pascal, Edwards Lifesciences, Irvine, California (courtesy of Edwards Lifesciences); panel c = NeoChord, Inc., St Louis Park, Minnesota (courtesy of Neochord), mitral valve annulus (panel d = Cardioband, Edwards Lifesciences) (Courtesy of Edwards Lifesciences); panel e = Carillon Mitral Contour System, Cardiac Dimensions, Kirkland, Washington (reproduced with permission from Witte et al. [29]) and total mitral valve replacement (panel f = apical
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