Echocardiographic determination of the etiology of severe mitral regurgitation

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Diseases affecting one or more of the components of the mitral apparatus (papillary muscles, chordae tendineae, mitral valve leaflets, and annulus) often cause mitral regurgitation.1 The natural history, surgical therapy, and prognosis may vary with etiology.2 A noninvasive diagnostic method for distinguishing different types of mitral insufficiency is needed.

Recent studies have emphasized the echocardiographic findings of diverse causes of mitral regurgitation.3–15 In cases of rheumatic mitral regurgitation, the mitral valve has been found to be thickened, with increased echo amplitude and with an EF slope which may be decreased, normal, or increased.3, 9, 13, 15 Prolapsing mitral valve is associated with a pansystolic or late systolic posterior motion of one or both leaflets.3, 4, 7, 11, 12 The echocardiographic findings in ruptured posterior leaflet chordae tendineae include systolic separation of the mitral leaflets,3–14 paradoxical early diastolic anterior motion of the posterior leaflets,3 demonstration of a posterior leaflet which, after moving anteriorly during early diastole, remains in this abnormal position throughout diastole.16 In ruptured chordae of the anterior leaflet, a diastolic, coarse, chaotic fluttering of the anterior leaflet may be noted.14

This study reports the echocardiographic findings in 21 patients with severe mitral regurgitation secondary to rheumatic mitral valvular disease, prolapsing mitral valve leaflets, and patients with ruptured chordae tendineae. All diagnoses were corroborated by cardiac catheterization and direct surgical visualization of the mitral apparatus.

Materials and methods

Twenty-one patients who had surgical reconstruction or replacement of the mitral valve were selected for this study. The criteria for. . .



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