Document Detail

Biomechanical and echocardiographic characterization of flail mitral leaflet due to myxomatous disease: further evidence for early surgical intervention.
MedLine Citation:
PMID:  15215804     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Flail mitral leaflet (FML) is a common complication of mitral valve prolapse, often leading to severe mitral regurgitation (MR) and left ventricular dysfunction. In the absence of timely surgical correction, survival is significantly impaired. Early recognition of FML and identification of risk factors is important because early intervention increases the chances of survival. METHODS: We studied 123 patients undergoing mitral valve surgery for severe MR caused by myxomatous disease. Chart review, echocardiography, and tensile testing were performed. RESULTS: Thirty-eight patients had FML, and 85 patients had non-flail mitral leaflet (non-FML). Patients with FML were younger (53.7 +/- 1.8 vs 59.3 +/- 1.4 years, P =.02), had more severe MR (3.89 +/- 0.04 vs 3.76 +/- 0.04, P =.02), were less likely to be in New York Heart Association class III or IV heart failure (5% vs 20%, P =.037), and were less likely to have bileaflet mitral valve prolapse (5% vs 38%, P <.001) than non-FML patients. Valve tissue from patients with FML had less stiff chordae (23.5 +/- 3.6 vs 59.1 +/- 11.7 Mpa, P =.006) that tended to have a lower failure stress (3.8 +/- 0.9 vs 9.6 +/- 2.2 Mpa, P =.07) and had more extensible leaflets (56.4% +/- 7.9% vs 42.9% +/- 2.7% strain, P =.04) compared with that of non-FML patients. CONCLUSIONS: The development of FML may result from intrinsic tissue abnormalities and is associated with a distinct subset of the myxomatous population. Identification of such clinical characteristics in this population and knowledge of an implicit mechanical abnormality of valve tissue may further the argument for early surgical correction.
William R Mills; J Edward Barber; Norman B Ratliff; Delos M Cosgrove; Ivan Vesely; Brian P Griffin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  148     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-24     Completed Date:  2004-10-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  144-50     Citation Subset:  AIM; IM    
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Chordae Tendineae / pathology,  ultrasonography
Echocardiography, Transesophageal
Heart Valve Diseases / etiology*,  pathology,  ultrasonography
Heart Valve Prosthesis Implantation
Middle Aged
Mitral Valve / pathology*,  ultrasonography
Mitral Valve Insufficiency / etiology,  surgery,  ultrasonography
Mitral Valve Prolapse / complications*,  surgery,  ultrasonography
Risk Factors
Rupture, Spontaneous / etiology

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