Background. Severe mitral regurgitation (MR) is one of the most important complications of mitral valve prolapse (MVP) and it often requires surgical treatment. This study is aimed to assess the relation of mitral valve morphology to severe MR complicated with MVP. Methods. Transesophageal echocardiography was performed in 37 patients with MVP and 30 control subjects. Results. The anterior mitral leaflet (AML) and posterior mitral leaflet (PML) were thicker and longer, and the mitral annulus was larger in patients with MVP than in control subjects (p<0.05). The degree of MVP correlated significantly with the leaflet thickness in systole (AML: r=0.70, PML: r=0.65, p<0.05). In patients with MVP without ruptured chordae tendineae (RCT), the severity of MR correlated significantly with the leaflet thickness, leaflet length and annular diameter (p<0.05). The prolapsed PMLs with RCT were thicker and longer than those without RCT (p<0.05). Conclusions. The leaflet thickness, leaflet length and annular diameter are "proportionally" redundant in patients with MVP, and the redundancy is closely related to the occurrence of RCT or severe MR.
Background. Little is known of the pathophysiologic characteristics of a common disease cohort with congestive heart failure (CHF) and preserved left ventricular (LV) systolic function. The objective of this retrospective study was to determine the differences in the echocardiographic features in patients with or without previous evidence of new-onset CHF in the outpatient setting using a selected common disease cohort. Methods and Results. We selected 72 consecutive outpatients, including 37 patients with hypertension, 16 with diabetes, 30 with hyperlipidemia, and/or 10 with coronary artery disease with no significant stenosis, having an early diastolic to atrial systolic transmitral flow velocity ratio (E/A) =<1, and an LV ejection fraction =>50%. The patients were divided into 2 groups according to the presence or absence of previous evidence of new-onset CHF: CHF group (n=7) and control group (n=65). Of the 72 patients, previous CHF was certified in 7 patients (9.7%). The LV mass index and maximal left atrial dimension were significantly greater (P < 0.05 and P < 0.005, respectively), and the systolic and early diastolic strain rates of the LV walls were significantly lower (both P < 0.05) in the CHF group than in the control group. There were no significant differences in peak systolic and early diastolic mitral annular motion velocities (Sw and Ew, respectively) and E/Ew between the 2 groups. Conclusions. Left atrial enlargement, LV hypertrophy, and LV systolic myocardial dysfunction are important in the development of CHF in patients with impaired LV relaxation and preserved LV pump function.
Background. The influence of functional MR over the long-term prognosis in decompensated CHF is unclear. We investigated whether the dynamic changes in degree of mitral regurgitation (MR) and mitral valve tenting during intensive therapy using two-dimensional echocardiography influence long-term prognosis in decompensated congestive heart failure (CHF). Methods. Forty patients who were admitted to our hospital for exacerbation of CHF were studied. Two-dimensional echocardiographic examinations were performed on admission and at discharge. Thirty eight patients who showed MR on admission were divided into two groups: MR responder, 31 patients with MR reduction during therapy; MR non-responder, 7 patients without MR reduction during therapy. The forty patients were also divided into two groups according to the tenting area: Tenting responder, 21 patients with tenting area reduction during therapy; Tenting non-responder, 19 patients without tenting area reduction during therapy. The long-term event rates of CHF and mortality rates were evaluated and compared by Kaplan-Meier method. Average follow-up period was 803±461days. Results. Incidence of recurrent CHF was significantly lower in MR responder than MR non-responder (15/31 vs. 6/7, p=0.017) and also significantly lower in Tenting responder than Tenting non-responder (8/21 vs. 15/19, p=0.005). Mortality rate was significantly lower in Tenting responder than Tenting non-responder (6/21 vs. 15/19, p=0.004). Conclusions. Reduction of mitral valve tenting area during intensive therapy predicted a good long-term prognosis of decompensated CHF.
The diagnosis of Marfan syndrome (MFS) is difficult because of the wide variability of clinical signs and the low specificity of many of the clinical signs. A 26-year-old woman showed only one major sign (skeletal features) and one minor sign (mitral valve prolapse) in the doctor's office. Magnetic resonance (MR) images revealed extensive dural ectasia with significant expansion of the dura. We thus diagnosed her with MFS according to the Ghent Nosology. Our patient had typical skeletal findings of MFS and displayed mitral valve prolapse, but not enlargement of aortic root. In such patients, it would be useful to detect dural ectasia by MRI in the diagnosis of MFS.
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