title: Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography.
abstract: BACKGROUND
  This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR).
  
  
  METHODS
  Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR), including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed.
  
  
  RESULTS
  Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%), 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity). Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic accuracy). None of the 8 non-concordant 2D-TTE reports were in complete disagreement with SR. P2 scallop was always involved in posterior leaflet prolapse or flail and was described correctly by 2D-TTE in 68 out of 69 patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior leaflet was involved in 14 patients (18%); A2 segment was involved in all of those cases and was correctly detected by 2D-TTE in 13 (98,7% agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial para-commissural prolapse or flail had a lower prevalence (14% and 10% respectively), with 2D-TTE sensitivity respectively of 64% and 50%.
  
  
  CONCLUSIONS
  2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2), which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases.
authors.affiliation: Department of Cardiovascular Science, S Camillo-Forlanini Hospital, Rome, Italy. giovanni.minardi@libero.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
authors.forename: Paolo Giuseppe
authors.initials: PG
authors.lastname: Pino
authors.forename: Carla Clotilde
authors.initials: CC
authors.lastname: Manzara
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Giulio Giuseppe
authors.initials: GG
authors.lastname: Stefanini
authors.forename: Giuseppe Nicola
authors.initials: GN
authors.lastname: Viceconte
authors.forename: Stefania
authors.initials: S
authors.lastname: Leonetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Madeo
authors.forename: Carlo
authors.initials: C
authors.lastname: Gaudio
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care / Q000592:standards; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index