title: Mild rheumatic mitral regurgitation in the presence of dominant stenotic pliable valve: an echocardiographic structural valve analysis in patients undergoing balloon valvuloplasty.
abstract: BACKGROUND
  Understanding the mechanism and the main components involved in rheumatic mitral regurgitation (MR) associated with dominant pliable mitral stenosis (MS) may improve our ability to repair some mixed rheumatic mitral valve pathologies.
  
  
  OBJECTIVE
  To assess mitral valve structural components in pure mitral stenosis versus mitral stenosis associated with mild regurgitation
  
  
  METHODS
  Using two-dimensional echocardiography, we performed mitral valve structural analysis in two groups of patients prior to balloon mitral valvuloplasty (BMV). The first group, consisting of 13 females and 2 males (mean age 39 +/- 5 years), suffered from pure pliable mitral stenosis (PPMS), while the second group, with 22 females and 2 males (mean age 44 +/- 5 years), had mixed mitral valve disease (MMVD) characterized by mild MR in the presence of dominant pliable MS. All echocardiographic measurements relating to the mechanism of MR were undertaken during the systolic phase.
  
  
  RESULTS
  The mean Wilkins scores of the PPMS and MMVD groups were 7 +/- 1 and 8 +/- 1 respectively (P = 0.004). No significant differences were found between the MMVD group and the PPMS group regarding annular circumference (15.5 +/- 1.4 cm vs. 15.4 +/- 1.6cm, P = 0.84), annular diameter (36 +/- 4 mm vs. 38 +/- 5 mm, P = 0.18), and chordae tendinae length directed to the anterior mitral leaflet (AML) (10 +/- 2 mm vs. 11 +/- 2 mm, P = 0.137). However, anterior vs. posterior mitral leaflet length during systole was significantly lower in the MMVD than in the PPMS group (2.2 +/- 0.5 vs. 2.8 +/- 0.4, P = 0.02), whereas the AML thickness at the co-aptation point was greater in the MMVD than in the PPMS group (7 +/- 1 vs. 5 +/- 1 mm, P = 0.0004).
  
  
  CONCLUSIONS
  In rheumatic valves, thickening and shortening of the AML are the main factors determining the appearance of mild MR in the presence of dominant pliable MS.
authors.affiliation: Heart Institute, Emek Medical Center, Afula, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Turgeman
authors.forename: Alexander
authors.initials: A
authors.lastname: Feldman
authors.forename: Khaled
authors.initials: K
authors.lastname: Suleiman
authors.forename: Limor I
authors.initials: LI
authors.lastname: Bishari
authors.forename: Idit
authors.initials: I
authors.lastname: Lavi
authors.forename: Lev
authors.initials: L
authors.lastname: Bloch
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index