["Incomplete closure" of the mitral valve: the relationships to valvular regurgitation and to the morphofunctional characteristics of the left ventricle].
OBJECTIVE
The present study was designed in order to evaluate the prevalence of mitral regurgitation in patients with the "incomplete mitral leaflet closure" echocardiographic pattern, to verify whether the amount of "incomplete mitral leaflet closure" is related to the severity of mitral regurgitation and, last, to verify the relation between the "incomplete mitral leaflet closure" and left ventricular morphology and function.


METHODS
We studied 80 patients (14 patients with dilatative cardiomyopathy, 26 patients with coronary artery disease, and 40 patients with hypertensive heart disease or aortic valve disease) showing the "incomplete mitral leaflet closure" pattern, retrospectively selected from a population composed of 1700 consecutive patients routinely examined in our echocardiographic laboratory. In all patients we evaluated the presence and the severity of mitral regurgitation, the morphological and functional parameters of the left ventricle, the systolic diameter of the mitral annulus, the distance between the point of mitral leaflet coaptation and the annular plane, and the incomplete mitral closure area, assuming the last two parameters as indexes of the severity of incomplete closure of the mitral valve.


RESULTS
We observed the presence of mitral regurgitation in 51 out of 80 patients (64%). The valvular insufficiency was considered mild in 78% of the patients. We observed no significant difference between patients with mitral regurgitation and without, as regards the diameter of the mitral annulus, the distance between the point of mitral leaflet coaptation and the annular plane, and the incomplete mitral closure area in different types of heart diseases. The incomplete mitral closure area and the diameter of the mitral annulus showed a significant, although not elevated, correlation with the severity of the mitral regurgitation (r = 0.36 and r = 0.32, respectively). The severity of mitral regurgitation showed significant correlations with all of the left ventricular morphological and functional parameters evaluated. Finally, we observed significant correlations between the incomplete mitral closure area and all of the morphological and functional parameters of the left ventricle.


CONCLUSIONS
On the basis of the results obtained we can conclude that: 1) the "incomplete mitral leaflet closure" pattern does not appear to be a highly specific marker of mitral regurgitation, 2) this pattern appears to be related to the morphology and function of the left ventricle, and 3) the severity of the incomplete mitral valve closure is more easily evaluated by a parameter that takes into account the numerous factors acting on the mitral apparatus, that is the incomplete mitral closure area.
Castini
D
D
Divisione di Cardiologia, Utic Marco O. Triulzi, Ospedale Bassini, Milano.
Gentile
F
F
Mangiarotti
E
E
Donzelli
W
W
Ornaghi
M
M
Leali
F
F
Triulzi
M O
MO
Maggi
G C
GC
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000706:statistics & numerical data; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D012189:Retrospective Studies; D016277:Ventricular Function, Left