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BACKGROUND Complete atrioventricular septal defects (CAVSD) include a variable spectrum of congenital malformations with different forms of clinical findings. We examined early and midterm outcomes, the need for reoperation, postoperative residual AV valve regurgitation, and other risk factors after various CAVSD repairs. METHODS Between 2014 and 2018, we have performed 89 isolated CAVSD repairs. We retrospectively reviewed the patients' medical records. Patients were divided into three groups according to their repair techniques modified one patch repair (MP) (n = 16); two patch repair (TP) (n = 49); and left anterior leaflet augmentation (ALA) technique (n = 24). RESULTS Eighty patients (89.8%) survived hospital discharge. Early mortality rates were three (18.8%) in the group MP, five (10.2%) in the group TP, and one (4.2%) in the group ALA. Thirteen patients died during the follow-up period. Late mortality rates were three (18.8%) in the group MP, four (16.6%) in the group ALA, and six (12.2%) in the group TP. The mean follow-up time was 35.9 ± 22.97 months (range: 0.3-77 months). The morbidity and mortality results were similar between-group TP and ALA but worse in the MP group. Low body weight (

In Ebstein's anomaly, the points of attachment, or hinges, of the septal and mural leaflets in the right ventricle are displaced away from the atrioventricular junction. In contrast, the junctional hinge of the anterior leaflet usually retains a normal position. Here, we report a case of giant right atrial aneurysm due to isolated displacement of the anterior leaflet of the tricuspid valve in an infant, a rare variant of Ebstein's anomaly. Enlargement of the right atrium, which was initially diagnosed during the fetal period, progressively and markedly dilated after birth and was successfully treated with surgical resection. Isolated displacement of the anterior leaflet should be recognized as a variant of Ebstein's anomaly.

The most common mitral valve (MV) disease is the MV regurgitation, in which the anterior leaflet and the posterior leaflet cannot coapt well and hence result in the leaking of blood from the left v...

Nordrum IS, Skallerud B. Smooth muscle in the human mitral valve: extent and implications for dynamic modelling. APMIS 2012. The mitral valve is increasingly been regarded as having dynamic and contractile capabilities, but the presence of muscle in the valve has been investigated to a limited extent. The aim of this study was to investigate the presence, architecture and phenotype of muscle in the human mitral valve. Twelve mitral valves were cut into strips, sectioned for histology, and the cut edges examined by microscope after staining included immunophenotyping. Smooth muscle bundles were present at the atrial side of the leaflets, and distinctly more in the anterior leaflet than in the posterior leaflet. The smooth muscle bundles extended up to two-thirds the distance from the annulus to the rim of the leaflets, and they ran in various directions, but seemingly mainly perpendicular to the annulus. The thickness and density of the bundles seemed to decrease with the distance from the annulus, and also in a radial direction from the centre portion of each leaflets attachment at the annulus towards the rim. Cross striation was not detected. Cardiac muscle in the left atrial wall extended into the annular base of the leaflets in close proximity to the annular border of the smooth muscle bundles in the leaflets. In conclusion, especially the anterior leaflet of the mitral valve seems to have a separate smooth muscle formed as a meshwork of bundles close to the atrial surface.

In this work we investigated which mitral valve leaflet was most often involved in mitral valve prolapse with degenerative mitral valve disease and whether there was an association with breed, age, gender, or weight. Five hundred and thirty-seven dogs with mitral valve prolapse-degenerative mitral valve disease were assessed; the cross-breed dog was the most represented breed (248 dogs, 46.2%). Mitral valve prolapse was more common in male dogs, and the average age was 11.3 +/- 2.8 years. Prolapse of the anterior leaflet was present in 48.4% of dogs, prolapse of the the posterior leaflet in 7.1%, and bileaflet prolapse was present in 44.5%; this distribution is different than that typically found in humans. There was a significant correlation between severity of mitral regurgitation and severity of mitral valve prolapse or ISACHC class, and between severity of mitral valve prolapse and ISACHC class. There was no relationship between the particular affected leaflet(s) and severity of mitral regurgitation, severity of mitral valve prolapse, or ISACHC class. Our findings suggest that the susceptibility to the mitral valve prolapse-degenerative mitral valve disease is not confined to a specific breeds and that the specific leaflet prolapsing is different in dogs compared with humans.

SUMMARY: Echocardiography tracings of the pulmonary valve was recorded in 16 patients with pulmonic stenosis (PS) ranging in ages from 6 to 14 years (average 10 years). 11 patients had an isolated PS and 5 had a PS associated with atrial septal defect. In 2 patients with mild PS (gradient 15 mm Hg) the depth of the “a” wave was normal: 3 and 4 mm. In 14 patients with moderate or severe PS (gradient 40 mm to 200 mm Hg), the maximal depth of the “a” wave was less than 6 mm in 2 patients, and more than 6 mm in 12 patients (range 7 to 15 mm, average 10 mm). The motion of both anterior and posterior pulmonary valve leaflets was well recorded in 3 patients with severe PS. The “a” wave showed a posterior motion of the posterior leaflets and an anterior motion of the anterior leaflet. This motion is due to the premature pulmonary valve opening.

BACKGROUND: Noninvasive and accurate assessment of mitral valve anatomy has become integral in the presurgical evaluation of patients with mitral valve prolapse (MVP). Recently developed real time three-dimensional (RT3D) ultrasound allows online acquisition, rendering, and can provide accurate information on cardiac structures. We sought to evaluate the feasibility of RT3D for the assessment of MVP segments when compared with transesophageal echocardiography (TEE) and intraoperative findings. METHODS: We examined 42 patients with MVP using RT3D, two-dimensional (2D) transthoracic echocardiography (TTE) and TEE. For RT3D analysis, cropping planes were used to slice the 3D volume on line to visualize the prolapsed segments of the mitral valve leaflets. The mitral valve was divided into six segments based on the American Society of Echocardiography's recommendations. Two experienced cardiologists evaluated echocardiographic images. RESULTS: Adequate RT3D images of the mitral valve were acquired in 40 out of 42 patients. The sensitivity and specificity of RT3D for defining prolapsed segments when compared with TEE were 95% and 99%, respectively (anterior leaflet: 96% and 99%, posterior leaflets: 93% and 100%, respectively). The sensitivity and specificity of TTE were 93% and 97%, respectively (anterior leaflet: 96% and 98%, posterior leaflets: 90% and 97%, respectively). Interobserver agreement for RT3D (Kappa 0.95, 95% confidence interval [CI] 0.91-1.00) was significantly greater than for TTE (Kappa 0.85, 95% CI 0.78-0.93) (P < 0.05). The elapsed time for completion of RT3D (14.4 +/- 2.8 min) was shorter than for TEE (26.4 +/- 4.7 min, P < 0.0001) and TTE (19.0 +/- 3.1 min, P< 0.0001). CONCLUSIONS: RT3D is fast, accurate, and highly reproducible for assessing MVP.

We report a case of isolated cleft mitral valve with two clefts in the posterior and one in the anterior leaflet. Our case adds to the few reports of posterior and multiple mitral valve clefts and to our knowledge is the first using real-time transoesophageal three-dimensional echocardiography (3DE) for assessment of isolated cleft mitral valve. (Echocardiography 2010;27:E50-E52).

Posterior mitral valve (MV) leaflet aneurysms are extremely rare complications of infective endocarditis (IE). When MV aneurysms occur, they usually involve the anterior leaflet. Real time three-dimensional transesophageal echocardiography (RT3D TEE) has been recently developed and provides views of unparalleled quality by optimizing visualization of spatial relationships. We present a rare case of a posterior MV leaflet aneurysm due to IE in a 64-year-old woman, best visualized by RT3D TEE.

We are describing two-dimensional and live/real time three-dimensional transthoracic as well as two-dimensional transesophageal echocardiographic findings in an elderly patient with epithelioid hemangioma involving the anterior leaflet of the mitral valve.

Objectives To describe predictors of the number of MitraClip devices implanted during percutaneous repair of mitral regurgitation (MR), and the long-term reduction in MR. Background In the EVEREST trials, one or two MitraClip devices were implanted to reduce MR, as needed. Methods Preprocedural transthoracic echocardiograms (TTE) and transesophageal echocardiograms (TEE) of 233 subjects who received 1 or 2 MitraClip devices in the EVEREST II Randomized Trial and High-Risk Study were analyzed. TEEs were reviewed for etiology of MR and pathoanatomic features of the valve, valve apparatus, and the regurgitant jet. Follow-up MR was assessed by TTE postprocedure and at 12 months. Results Ninety-seven subjects (42%) had two MitraClip devices implanted. Subjects with quantitatively more severe MR were more likely to receive two devices [mean regurgitant volume (RV) 45.9 ± 21.9 vs. 36.3 ± 18.5 mL, P

Objective: To describe thoroughly and quantitatively the morphologic features of the human tricuspid valve, to define and classify classify certain prominent normal variations, and to offer a clear and concise terminology for describing its morphology. Background. In recent years there has been growing interest in the tricuspid valve. Noninvasive imaging is now commonplace and remarkably detailed. Surgical interventions involving the tricuspid valve have become increasingly common. These factors underscore the need variations. Methods. Quantitative and anatomic features of the tricuspid valve were studied in 24 normal hearts at autopsy from subject evenly distributed by age and sex. Leaflet length, surface area, chordal number, and leaflet morphology were recorded. Results. Valves demonstrated some degree of leaflet subdivision in 92% of cases. Mean tricuspid valve length was 11.3 ± 0.1 cm and the surface area was 21.0 ± 1.1 cm2. Mean lengths and surface areas were similar for the anterior, posterior, and septal leaflets (38–42 mm and 5.9–7.8 cm2, respectively). However, for a given valve, the longest leaflet could be twice the length and three times the area of the smallest. Calculated valvular diameter was 2.13 ± 0.03 cm/m2. The tricuspid valve was served by and average of 170 ± 36 chordae tendineae, 49% inserted on the free edge of the valve, 44% on the undersurface, and 7% on the basal regions. Chordal density (number of chordae/cm2) was greater in women than men (9.9 ± 0.5 vs. 7.3 ± 0.7 chordae/cm2, P < 0.02). The septal leaflet had the greatest chordal density and the anterior leaflet the lowest (12.7 ± 0.9 vs. 5.9 ± chordae/cm2). Conclusions. The concept of chordal density for the tricuspid valve has not been previously described and may be clinically relevant in the pathogensis of valvular prolapse. Modifications of existing tricuspid valve nomenclature are suggested. © 1993 Wiley-Liss, Inc.

Between October 1986 and May 1991, 19 patients with acute rheumatic fever who were hospitalized in the Department of Pediatrics at Soroka Medical Center underwent echocardiographic color flow Doppler examination. Five patients had an echocardiographic picture of mitral valve prolapse, with or without leaflet thickening, and one had a flail anterior leaflet. Six had mitral valve thickening without prolapse, and seven patients had an echocardiographically normal appearing mitral valve. All 19 patients had a posterolaterally directed jet of mitral regurgitation demonstrated on color flow Doppler. All patients had echocardiographically normal aortic valves. However, mild aortic regurgitation was noted in eight of them. The posterolateral jet of mitral insufficiency in acute rheumatic fever may be the most common echo-Doppler finding in this condition. (ECHOCARDIOGRAPHY, Volume 8, November 1991) Summary and Conclusions

A 55-year-old woman was diagnosed with endocarditis involving the aortic valve and resulting in moderate aortic insufficiency. Transesophageal and transthoracic echocardiography demonstrated an unusually accentuated diastolic anterior motion of the anterior mitral valve leaflet toward the interventricular septum. The anterior leaflet remained within a few millimeters of the septum throughout diastole, with a narrow jet of aortic insufficiency separating the anterior leaflet from the septum. We hypothesize that the particularly long anterior mitral leaflet was drawn toward the septum during diastole due to the Venturi effect of the aortic insufficiency jet within a narrow ventricular outflow tract. This accentuated diastolic anterior motion may be a diastolic correlate of systolic anterior motion of the mitral valve.

A 33-year-old woman was referred to our echocardiography laboratory because of loud murmur at the apex. Transthoracic and transesophageal echocardiography (TTE and TEE) showed a mass involving the anterior leaflet of the mitral valve. Real time three-dimensional TEE (RT3D TEE) images clearly showed the nodular, irregular and large size of the mass. Based on her laboratory findings and the echocardiographic appearance of the mass, Libman-Sacks endocarditis was prediagnosed. In intraoperative inspection, a large nodular tumor was shown on the atrial side of the anterior mitral valve leaflet. In this case, RT3D TEE is better than all echocardiographic imaging modalities in evaulating vegetation of Libman-Sacks endocarditis.

The degree of systolic movement of the tricuspid valve (TV) leaflets was measured in 100 consecutive apparently healthy men 18-20 years old at the time of maximum posterosuperior motion toward or into the right atrium. Backward bowing of greater than 0.20 mm2 of the anterior leaflet, and greater than 0.15 mm2 of either the posterior or septal leaflets beyond the plane of the tricuspid annulus was found in 5% or less of the cohort irrespective of the echocardiographic view in which it was recorded. The upper 5% of these young men had greater than 0.80 mm2 of backward bowing when the leaflet motion was summed from all three views. The anterior leaflet demonstrated more bowing than either the septal or posterior leaflets. The systolic TV prolapse area correlated highly with the degree of mitral leaflet prolapse (r = 0.654, p less than 0.001). We conclude that there is a wide continuous spectrum of tricuspid valve leaflet prolapse area in healthy young men. This quantitative approach may help standardize the echocardiographic evaluation of tricuspid leaflet motion.