title: Quantification of annular dilatation and papillary muscle separation in functional mitral regurgitation: role of anterior mitral leaflet length as reference.
abstract: BACKGROUND
  We hypothesized that anterior mitral leaflet length (ALL) does not differ significantly between normal subjects and patients with functional mitral regurgitation (FMR) and hence may be used as a reference measurement to quantify annular dilatation and papillary muscle separation.
  
  
  RESULTS
  We prospectively studied 50 controls, 15 patients with systolic left ventricular dysfunction (LVD) with significant FMR, and 15 patients with LVD without significant FMR. Significant MR was defined as an effective regurgitant orifice area > or = 0.2 cm2 as measured by the flow convergence method. Annular diameter, interpapillary distance, and ALL were measured, and the following ratios were derived: annular diameter indexed to ALL (ADI) and interpapillary distance indexed to ALL (IPDI). There was no significant difference in ALL among the three groups. The mean ADI was 1.26 times controls in patients with LVD without significant FMR compared to 1.33 times controls in patients with LVD with significant FMR (P = 0.06, no significant difference between groups). The mean IPDI was 1.42 times controls in patients with LVD without significant FMR compared to 2.1 times controls in patients with LVD with significant FMR (P < 0.0001, significant difference between groups).
  
  
  CONCLUSIONS
  There was no significant difference in ALL between controls and patients with LVD. ALL can be used as a reference measurement to quantify annular dilatation and papillary muscle separation in patients with FMR. Interpapillary distance but not annular diameter indexed to ALL correlates with severity of FMR.
authors.affiliation: Our Lady of Mercy University Hospital of New York Medical College, Bronx, NY, USA. vjorapur@yahoo.com
authors.forename: Vinod
authors.initials: V
authors.lastname: Jorapur
authors.forename: Apostolos
authors.initials: A
authors.lastname: Voudouris
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lucariello
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004108:Dilatation, Pathologic; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010210:Papillary Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology