Year: 2024 | Month: December | Volume: 14 | Issue: 12 | Pages: 92-105
DOI: https://doi.org/10.52403/ijhsr.20241211
Mitral Valve Deformation Evaluated as a Determinant of Ischemic MR Severity Using Transesophageal Echocardiography in Subjects Undergoing Surgical Myocardial Revascularization with or without concomitant Mitral Valve Procedure
Abhijeet B. Shitole1, Veerappa A. Kothiwale2, Anushri P. Patil3, Sharanagouda S. Patil4, Anand T. Vagarali5
1Department of Cardiac Anaesthesiology, 2Department of General Medicine, 3Department of Epidemiology and Biostatistics, 4Department of Cardiac Anaesthesiology, 5Department of Cardiac Anaesthesiology
Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (KAHER) Deemed to be University, Belagavi, Karnataka, India.
Corresponding Author: Abhijeet B. Shitole
ABSTRACT
Background: Ischemic Mitral Regurgitation (iMR) is a result of functional imbalance between mitral valve leaflets tethering and closing forces caused by left ventricular remodeling following myocardial infarction. This mechanistic mitral valve deformation can be a predictor of ischemic MR severity. Present study was aimed at evaluating mitral valve deformation in different grades of ischemic MR in subjects with varying grades of MR undergoing myocardial revascularization surgery with or without concomitant mitral valve procedure.
Material and methods: 196 subjects undergoing surgical myocardial revascularization with or without concomitant mitral valve procedure were evaluated for presence of ischemic MR and mitral valve deformation. MR was quantified using echo indices like vena contracta width (VCW), Effective regurgitant orifice area (EROA), Regurgitant volume (RVol) & Regurgitant fraction (RF) into either “No” or “Mild,” “Moderate” and “Severe” ischemic mitral regurgitation (iMR) groups. The degree of mitral valve deformation was evaluated using systolic indices of deformation like tenting area, tenting height, and posterior leaflet angle. Systolic and diastolic mitral annular diameters, areas and annular height to commissural width ratio also were compared in different grades of ischemic MR.
Results: Mean MV systolic tenting area (TA) (1.87±0.42, 2.15±0.46 & 3.65± 0.26 vs. 1.34±0.44) (cm2) (p<0.001), Tenting height (Th) (1.19±0.25 , 1.33±0.27 & 2.13±0.19 vs. 0.88±0.27) (cm) (p<0.001) and posterior mitral leaflet angle (PMLAβ) (50.96±8.85, 53.74±8.53 & 62.66±8.76 vs. 35.52 ±6.82) (0) (p<0.001) were significantly higher in mild, moderate & severe groups vs. no iMR group respectively. The degree of MV deformation increased with increasing grade of MR in a linear manner.
Conclusion: Higher degree of MV deformation was seen with higher grades of ischemic MR. Both systolic and diastolic mitral valve deformation indices predicted ischemic MR severity in patients undergoing myocardial revascularization surgery with or without the concomitant mitral valve procedure. Ischemic mitral regurgitation, Vena contracta width, Effective regurgitant orifice area, Mitral valve deformation, Tenting area, Tenting height, Posterior leaflet angle.
Key words: Ischemic mitral regurgitation, Vena contracta width, Effective regurgitant orifice area, Mitral valve deformation, Tenting area, Tenting height, Mitral valve posterior leaflet angle.