Document Detail

'Frozen' posterior mitral leaflet in rheumatic mitral stenosis: incidence and impact on outcome of balloon mitral commissurotomy.
MedLine Citation:
PMID:  15974519     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: The incidence and clinical significance of immobile and 'frozen' posterior mitral leaflet (FPML) were evaluated in the pathophysiology and immediate outcome of patients with severe pliable mitral stenosis (MS) undergoing percutaneous balloon mitral commissurotomy (PBMC). METHODS: During the past four years, 30 'ideal' patients (mean age 46 +/- 8 years) with Wilkins' score <8, bilateral commissural fusion and absence of commissural calcification underwent peri-procedural echocardiographic analysis. Anterior mitral leaflet (AML) mobility index (MI), chordae tendineae (CT) length, and mitral valve area (MVA) were evaluated. RESULTS: Pre-procedure FPML was noted in 28 patients (93%). All patients achieved MVA > or = 1.5 cm2. Post-procedure MVA in patients with bilateral commissural splitting was 1.9 +/- 0.2 cm2 versus 1.6 +/- 0.1 cm2 in patients with unilateral commissural splitting (p < 0.05). CT lengths directed to the AML and PML were 15 +/- 2 mm and 8 +/- 2 mm, respectively (p < 0.05). MI of the AML before and immediately after PBMC was 0.4 and 0.6, respectively (p < 0.05). None of the patients with FPML showed improved mobility following successful PBMC. CONCLUSION: FPML may be found in most patients with pliable MS. It is mainly a result of short, rigid and fused CT directed to the PML. A 'single-wing door' or a unicuspid valve may be used as a model for rheumatic pliable MS. It is suggested that pre-procedure leaflet morphology and functional assessment should focus on the AML.
Yoav Turgeman; Shaul Atar; Alexander Feldman; Mohamed Jabaren; Khaled Suleiman; Lev Bloch; Tiberio Rosenfeld
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  14     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2005-09-13     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  282-5     Citation Subset:  IM    
Department of Cardiology, Ha'Emek Medical Center, Afula, Israel.
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MeSH Terms
Balloon Dilatation*
Chordae Tendineae / physiopathology,  ultrasonography
Echocardiography, Transesophageal
Middle Aged
Mitral Valve / pathology,  physiopathology*,  ultrasonography
Mitral Valve Stenosis / physiopathology,  therapy*,  ultrasonography
Papillary Muscles / physiopathology,  ultrasonography
Retrospective Studies
Rheumatic Heart Disease / physiopathology,  therapy*,  ultrasonography
Treatment Outcome

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