title: Quantitative real-time three-dimensional echocardiography provides new insight into the mechanisms of mitral valve regurgitation post-repair of atrioventricular septal defect.
abstract: BACKGROUND
  Mechanisms of mitral valve regurgitation after atrioventricular septal defect repair are unclear.
  
  
  METHODS
  To gain further insight into mitral valve regurgitation, real-time three-dimensional echocardiography was performed in 53 patients after atrioventricular septal defect repair (30 partial and 23 complete) and 40 controls. Mitral valve {x, y, z} coordinates from the annulus, leaflet surface, papillary muscle, and chordal attachments were recorded. Vena contracta area of the regurgitant jet(s) and volume of leaflet prolapse and tethering were measured.
  
  
  RESULTS
  Twenty-three patients had mild (group 1) and 30 moderate (group 2) mitral valve regurgitation. Patients in both groups 1 and 2 had more circular annuli than controls. Annular area was greater in group 2 than in group 1 and controls (P < .01). Group 2 had more frequent segmental prolapse in the superior-mural leaflet segment. The anterolateral papillary muscle was more laterally displaced in group 2 than in controls and group 1 at end-diastole (P = .01 and P = .05) and formed a more acute angle with the mitral valve annulus than in controls or group 1 (P = .01).
  
  
  CONCLUSIONS
  In patients with atrioventricular septal defects, significant mitral valve regurgitation is associated with leaflet prolapse, larger annular area, and lateral papillary muscle displacement.
authors.affiliation: Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mackie
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.forename: Ghassan
authors.initials: G
authors.lastname: Al-Naami
authors.forename: Akio
authors.initials: A
authors.lastname: Inage
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.forename: Nee S
authors.initials: NS
authors.lastname: Khoo
authors.forename: Timothy
authors.initials: T
authors.lastname: Colen
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Smallhorn
mesh_terms: D000328:Adult; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006343:Heart Septal Defects / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D016896:Treatment Outcome