title: Mitral valve geometry changes in patients with aortic regurgitation.
abstract: BACKGROUND
  Changes in mitral valve geometry in patients with significant aortic regurgitation (AR) have not been evaluated. The aim of the present study was to assess the prevalence of significant secondary mitral regurgitation (MR; grade ≥ 2) and the geometric characteristics of the mitral valve in patients with moderate and severe AR (grade ≥ 2) undergoing aortic valve and root surgery.
  
  
  METHODS
  One-hundred twenty patients (mean age, 54 ± 15 years; 65% men) with AR grade ≥ 2 undergoing aortic valve and root surgery were retrospectively evaluated. The presence of MR grade ≥ 2 and geometry of the mitral valve were assessed on preoperative transthoracic echocardiography. Left ventricular (LV) dimensions and mitral valve geometry were compared between patients with MR grade ≥ 2 and patients without.
  
  
  RESULTS
  MR grade ≥ 2 was present in 28 patients (23%). Patients with MR grade ≥ 2 had higher European System for Cardiac Operative Risk Evaluation II scores and more often used β-blockers and diuretics than their counterparts. Patients with MR grade ≥ 2 had larger tenting areas (mean, 1.59 ± 0.79 vs 1.25 ± 0.41 cm(2); P = .003), larger inter-papillary muscle distances (mean, 28.4 ± 9.5 vs 24.8 ± 5.2 mm; P = .014), larger left atria (mean, 40.9 ± 13.7 vs 32.0 ± 12.2 mL/m(2); P = .002), and lower LV ejection fractions (mean, 47.3 ± 12.2% vs 54.3 ± 9.3%; P = .002) as compared to patients with MR grade < 2. However, there were no differences in indexed LV volumes. On multivariate logistic regression analysis, LV ejection fraction (odds ratio, 0.94; 95% confidence interval, 0.89-0.99; P = .018) and indexed left atrial volume (odds ratio, 1.05; 95% confidence interval, 1.01-1.10; P = .019) remained independently associated with MR grade ≥ 2 after correcting for tenting area and inter-papillary muscle distance.
  
  
  CONCLUSIONS
  Among patients with AR grade ≥ 2 undergoing aortic valve and root surgery, the prevalence of MR grade ≥ 2 was 23%. Lower LV ejection fraction and larger left atrial volume were independently associated with MR grade ≥ 2.
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Madelien V
authors: MV
authors: Regeer
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Ibtihal
authors: I
authors: Al Amri
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Michel I M
authors: MI
authors: Versteegh
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Nina Ajmone
authors: NA
authors: Marsan
authors: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.
authors: Victoria
authors: V
authors: Delgado
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Aortic valve disease; Mitral regurgitation; Transthoracic echocardiography