title: Abnormal mitral-aortic intervalvular coupling in mitral valve diseases: a study using real-time three-dimensional transesophageal echocardiography.
abstract: BACKGROUND
  Mitral and aortic valves are coupled via fibrous tissue. This coupling is considered to be important for cardiac function before and after mitral valve surgery. The relationship between mitral-aortic coupling and different types of mitral regurgitation (MR) is not completely understood.
  
  
  RESULTS
  Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) was performed in 133 subjects: 30 normal subjects, 15 patients with Carpentier type I MR (annular dilatation and congenital cleft), 40 type II (mitral valve prolapse), 20 type IIIa (rheumatic) and 28 type IIIb (ischemic mitral regurgitation). Custom software was used to track mitral (MA) and aortic annuli (AoA) in 3D space throughout cardiac cycle, allowing measurement of changes in mitral and aortic valve morphology. Normal mitral-aortic coupling is characterized by reciprocal changes in the annular areas throughout cardiac cycle, with systolic reduction of the angle between the two annular planes. In Carpentier type II patients, not only MA but also AoA areas were increased (P < 0.05 vs normal), but the reciprocal pattern of mitral-aortic coupling was preserved. In both type I IMR and IIIb patients, MA and AoA areas were both increased (P < 0.05 vs normal) and the reciprocal behavior of mitral-aortic coupling was lost. Only MA area was increased in type IIIa patients. The extent of mitral-aortic angle reduction during systole was diminished in all 4 Carpentier groups (P < 0.05 vs normal).
  
  
  CONCLUSIONS
  Mitral valve diseases may affect normal mitral-aortic coupling and aortic valve function. Different patterns of abnormal mitral-aortic coupling are associated with different Carpentier types of MR.
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Jen-Li
authors: JL
authors: Looi
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Alex Pui-Wai
authors: AP
authors: Lee
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Fang
authors: F
authors: Fang
authors: Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Ming C
authors: MC
authors: Hsiung
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Jing-Ping
authors: JP
authors: Sun
authors: Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Wei-Hsian
authors: WH
authors: Yin
authors: Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Jeng
authors: J
authors: Wei
authors: Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Shen-Kou
authors: SK
authors: Tsai
authors: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Song
authors: S
authors: Wan
authors: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Randolph Hl
authors: RH
authors: Wong
authors: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Malcolm J
authors: MJ
authors: Underwood
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Qing-Shan
authors: QS
authors: Lin
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Chun-Na
authors: CN
authors: Jin
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Liu
authors: L
authors: Chen
authors: Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. professorcmyu@gmail.com.
authors: Cheuk-Man
authors: CM
authors: Yu
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Echocardiography; Mitral regurgitation; Mitral valve prolapse; Mitral–aortic coupling