Echocardiographic evaluation of flail mitral valve: Comparison of transthoracic and transesophageal two dimensional and color doppler echocardiography

Kim, Seog Ho; Kim, Sung Hoon; Kang, Heung Sun; Choue, Chung Whee; Kim, Kwon Sam; Kim, Myung Shick; Song, Jung Sang; Bae, Jong Hoa

Abstract

BACKGROUND
Flail mitral valve due to ruptured chordae tendinae usually result in actue, severe mitral regurgitation. Because transesophageal echocardiography with color Doppler flow mapping permits high resolution imaging of mitral valve anatomy and mitral regurgitation, we compared this procedure with transthoracic echocardiography in the diagnosis and evaluation of flail mitral valve. METHODS: From 1990 to 1992 years, fourteen patients (7 males, 7 females ; age range 30-81years)with flail mitral valve admitted to Kyung Hee University was evaluated by transesophageal echocardiography and transthoracic echocardiography. RESULTS: 1) Transthoracic echocardiography revealed 11 cases of abnormal coaptation, I case of ruptured chordae tendinae and 2 cases not defined. Compared with transthoracic imaging, transesophageal echocardiography revealed 13 cases of abnormal coaptation and I case of ruptured chordae tendinae. 2) The site of flail leaflet was 6 cases in anterior, 7 cases in posterior and one case was not defined with transthoracic echocardiography. With transesophageal echocardiography, the site was 5 cases in anterior, 5 cases in posterior and 4 cases in both leaflets. 3) By color flow mapping, MR jet directed toward anterior in 5, posterior in 7 and both in 2 with transthoracic echocardiography. With transesophageal echocardiography,MR jet directed toward anterior in 5, posterior in 7 and both in 4. 4) In a flail anterior leaflet, transesophageal echocardiography showed abnormal leaflet coaptation in systole, displacement of the unsupported anterior leaflet into the left atrium and formation of a regurgitant channel between the mitral leaflets. By Doppler color flow pattern, mitral regurgitation associated with a flail anterior leaflet moved in a counter-clockwise direction around the left atrium in the standard 4 chamber view, whereas regurgitation associated with a flail posterior leaflet moved in a clockwise direction. Regurgitation associated with flail anterior and posterior leaflets moved in both directions. CONCLUSION: Transesophageal echocardiography with color Doppler flow mapping of mitral regurgitation were complementary to transthoracic echocardiography in the diagnosis and localization of flail mitral valve.