Clinical significance of mitral leaflet flail.
BACKGROUND
There has been scant academic consideration paid to investigations of mitral leaflet flail in terms of clinical profile, surgical strategy, and surgical outcome.


METHODS
One hundred consecutive patients with mitral leaflet flail referred for surgical treatment in the past 4(2/3) years were included in this study.


RESULTS
The most common reasons leading to mitral leaflet flail were chord rupture (38%), myxomatous degeneration (23%), and combined chord rupture and myxomatous degeneration (12%). Mitral leaflet flail was predominantly characterized by independent P(2) flail, followed by P(2,3) flail and independent A(2) flail. Chord rupture occurred in 54 patients, and the most commonly involved segments were P(2), P(2,3), and P(3). The most common risk factors for mitral valve replacement were papillary muscle rupture, extensive myxomatous degeneration, extensive chord rupture, and severely dilated mitral valve annulus. Multivariate regression analyses demonstrated that the development of mitral leaflet flail was significantly associated with the pertinent variables tested, especially correlated with insertion of the prosthetic ring, number of artificial chord, and presence of carotid stenosis.


CONCLUSIONS
Mitral leaflet flail may affect patients of any age, but is more prevalent among males and younger patients. Mitral chord rupture was the leading cause for mitral leaflet flail. Myxomatous degeneration, infective endocarditis, mitral annulus calcification, and papillary muscle rupture were the next most common causes. An increased incidence of mitral leaflet flail was closely related to the chords of the posterior leaflet and the middle scallop. Due to the progressive disappointing prognosis of mitral leaflet flail, surgery should be performed at an early stage.
Yuan
Shi-Min
SM
Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel. shi_min_yuan@yahoo.com
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications; D002815:Chordae Tendineae / Q000293:injuries; D004696:Endocarditis / Q000150:complications; D005260:Female; D006341:Heart Rupture / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016017:Odds Ratio; D010210:Papillary Muscles / Q000293:injuries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014463:Ultrasonography