Automatic Morphological Evaluation Using Three-Dimensional Transeophageal Echocardiography of Patients with Mitral Prolapse and Insufficiency: Comparison with Patients Without Cardiac Chambers Alterations

Background: There is paucity of information concerning automatic mitral valve apparatus analysis of patients with mitral valve prolapse (MVP). Objectives: We aimed to study with an automatic three-dimensional transesophageal echocardiography (TEE) dedicated software patients with moderate and severe mitral regurgitation when compared to patients with no structural cardiac chamber alterations (patients with patent foramen ovale (PFO) who underwent TEE) . Methods: We employed a TEE software dedicated to automatic analysis of 34 parameters of the mitral valve apparatus comparing MVP patients with moderate and severe mitral regurgitation and patients with PFO without cardiac chamber structural alterations. Mitral valve effective regurgitant orifice (ERO) and regurgitant volume were correlated to automatic MVP parameters. Results: 59 MVP patients and 43 PFO patients were analysed. All MVP patients presented P2 mitral valve prolapse, 15 (25.4 % ) with both posterior and anterior prolapse. Twenty-seven automatic parameters (79%) were different concerning MVP and PFO patients (p< 0.05): diameters, area, perimeter, height, angle, coaptation width, lenght, closure line lenght, annulus. ERO was 0.43 + 0.11 cm2 , and regurgitant volume: 62.2 + 14.9 ml/beat. Automatic analysis correlated to 75 percentile ERO MVP patients (ERO> 0.48 cm2): Posterior Leafltet Area (r:0.74, p:0.031); Posterior Leafltet Lenght (r:0.73, p:0.032); Tenting area (r:0,41, p:0.048). Conclusions: Automatic mitral valve parameters analysis were different concerning MVP and no structural cardiac chamber (PFO) patients. 75 percentile ERO MVP patients (ERO> 0.48 cm2) correlated to posterior leaflet parameters.This anatomic information could be useful to planning and surgical treatment of mitral valve prolapse patients.