title: Basal chordae sites on the mitral valve determine the severity of secondary mitral regurgitation.
abstract: OBJECTIVE
  To evaluate the variation between individuals in terms of basal chordae (BC) attachment sites on the mitral valve (MV) and the influence of this variation on secondary mitral regurgitation (MR) severity.
  
  
  BACKGROUND
  BC-mediated MV tenting is the main cause of secondary MR.
  
  
  METHODS
  In this prospective cross-sectional study, 38 consecutive patients with dilated or ischaemic cardiomyopathy who were due for cardiac transplantation underwent preoperative 3D full volume/colour Doppler echocardiography in sinus rhythm, and MV apparatus geometry, LV volume and MR severity were assessed. The lengths and insertion sites of four BC in the explanted hearts were measured post-transplantation before fixation.
  
  
  RESULTS
  Multiple linear regression analyses revealed that the anterior leaflet systolic tenting angle and bending angle associated with the distance between the medial and lateral BC insertion sites. By contrast, the posterior leaflet tenting angle associated largely with LV volume indices. The mean longitudinal distance of the four BC from the MV edge was the main determinant of the distal length of the anterior MV from the angulation point. Square root of effective regurgitant orifice area (√EROA) only associated significantly with the mean longitudinal distance of the outer two BC from the MV edge (r=0.509, p=0.001) among pathological parameters, and the central MV tenting area (r=0.524, p=0.001) among echocardiographical parameters. √EROA did not correlate with LV volume indices, LVEF or BC lengths.
  
  
  CONCLUSIONS
  BC insertion sites were associated with systolic anterior MV configuration and secondary MR severity in dilated LV and severe systolic dysfunction.
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jong-Min
authors: JM
authors: Song
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jae-Joong
authors: JJ
authors: Kim
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Tae-Yong
authors: TY
authors: Ha
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jae Won
authors: JW
authors: Lee
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Sung-Ho
authors: SH
authors: Jung
authors: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Il-Seon
authors: IS
authors: Hwang
authors: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Inchul
authors: I
authors: Lee
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Byung Joo
authors: BJ
authors: Sun
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Dae-Hee
authors: DH
authors: Kim
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Duk-Hyun
authors: DH
authors: Kang
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jae-Kwan
authors: JK
authors: Song
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D056910:Republic of Korea; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology