Mitral annular disjunction in patients with primary severe mitral regurgitation and mitral valve prolapse

二尖瓣脱垂 医学 二尖瓣反流 内科学 心脏病学 二尖瓣环 二尖瓣 左心房 心房颤动 舒张期 血压
作者
Toshiko Konda,Tohru Tani,Naoko Suganuma,Yoko Fujii,Ota M,Takeshi Kitai,Shuichiro Kaji,Yutaka Furukawa
出处
期刊:Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques [Wiley]
卷期号:37 (11): 1716-1722 被引量:21
标识
DOI:10.1111/echo.14896
摘要

Mitral annular disjunction is a structural abnormality of the mitral annulus fibrosus which is often associated with mitral leaflet prolapse. However, few reports have described mitral annular disjunction in mitral valve prolapse (MVP). This study aimed to investigate the characteristics of mitral annular disjunction in patients with severe mitral regurgitation (MR) caused by MVP.We reviewed 185 consecutive patients with severe MR caused by fibroelastic deficiency (FED) and Barlow's syndrome from March 2009 to December 2010. The upper limit of the disjunction was defined at the level of the posterior scallop's insertion into the left atrial wall, whereas the lower limit was defined at the level of the left atrium's connection to the ventricular myocardium. The distance between the two levels was called mitral annular disjunction. Prolapse sites in FED patients were categorized into anterior leaflet, posterior leaflet, and commissure groups. Patients with a disjunction distance of ≥2 mm were diagnosed with mitral annular disjunction.Annular disjunction was found in 45 patients (24%). Among them, the most common site of prolapse was the posterior leaflet (n = 35, 77.8%). During a median follow-up of 20.3 years, arrhythmic events and sudden death occurred in seven patients (3.8%).Mitral annular disjunction was detected in 24% of patients with severe MR and in 90% of the patients with Barlow's syndrome. There were significant differences at its sites of prolapse in FED patients. The presence and site of prolapse with mitral annular disjunction should be actively determined in FED patients.
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