[show abstract][hide abstract] ABSTRACT: BACKGROUND: Few data exist regarding the relation of the 3-dimensional (3D) morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse (MVP). METHODS AND RESULTS: Real-time 3D transesophageal echocardiography of the mitral valve was acquired in 112 subjects including 36 patients with MVP and significant MR (≥3+; MR+ group), 32 patients with MVP but no or mild MR (≤2+; MR- group), 12 patients with significant MR due to non-prolapse pathologies (non-prolapse group), and 32 normal subjects. The 3D geometry of mitral valve apparatus was measured with dedicated quantification software. Compared to normal and MR- groups, MR+ group had more dilated mitral annulus (p<0.0001), reduced annular height-to-commissural width ratio (AHCWR) (p<0.0001) indicating flattening of annular saddle-shape, redundant leaflet surfaces (p<0.0001), greater leaflet billow volume (p<0.0001) and billow height (p<0.0001), longer lengths from papillary muscles to coaptation (p<0.0001), and more frequent chordal rupture (p<0.0001). Prevalence of chordal rupture increased progressively with annulus flattening (7% vs 24% vs 42% for AHCWR>20%, 15%~20%, and <15%, respectively; p=0.004). Leaflet billow volume increased exponentially with decreasing AHCWR in patients without chordal rupture (r(2)=0.66, p<0.0001). MR severity correlated strongly with leaflet billow volume (r(2)=0.74, p<0.0001) and inversely with AHCWR (r(2)=0.44, p<0.0001). In contrast, annulus dilatation but not flattening occurred in non-prolapse MR patients. An AHCWR<15% (odds ratio=7.1, p=0.0004) was strongly associated with significant MR in MVP. CONCLUSIONS: Flattening of annular saddle-shape is associated with progressive leaflet billowing and increased frequencies of chordal rupture, and may be important in pathogenesis of MR in MVP.
[show abstract][hide abstract] ABSTRACT: PURPOSE: Late-onset atrial arrhythmia after successful closure of atrial septal defect (ASD) is not uncommon. Right atrial (RA) enlargement and increased electrocardiographic P-wave dispersion (Pd) independently predict the development of atrial arrhythmia. Data on the degree of right atrial (RA) geometrical and electrical remodeling following device closure of ASD are limited. METHODS: Echocardiography and electrocardiography (ECG) were performed in 58 consecutive patients (47±17years) before and at 3months after ASD closure. Persistent RA enlargement was defined as RA volume index (RAVI) ≥21ml/m(2) at 3months. Pd was calculated as the difference between maximal and minimal P-wave durations in 12-lead ECG. RESULTS: RA size reduced (RAVI: 50±28 vs. 26±16ml/m(2), p<0.001) and Pd on ECG decreased (53±17 vs. 49±20ms, p<0.05) significantly at 3months when compared to baseline. However, persistent RA enlargement remained evident in 31 patients (53%). As a group, they were older with higher pulmonary arterial systolic pressure, larger Qp/Qs, longer maximal P-wave duration and Pd than those with normalized RA. Pd reduction only occurred in patients with normalized RA size. The 3-month Pd (hazard ratio: 1.033, p<0.001) predicted the presence of incomplete RA geometrical remodeling. ROC curve revealed that Pd ≥45ms at 3months was 77% sensitive and 86% specific in revealing residual RA enlargement. CONCLUSION: Both atrial geometrical and electrical reverse remodeling were evident at 3months following ASD closure. However, only half of the included patients had normalization of RA size which could be revealed by a simple ECG surrogate of intra-atrial conduction disturbance.
International journal of cardiology 10/2012; · 7.08 Impact Factor