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Isolated annular dilation does not usually cause important functional mitral regurgitation

Comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy

Yutaka Otsuji, MD, FACC^*,*, Toshiro Kumanohoso, MD^*, Shiro Yoshifuku, MD^*, Keiko Matsukida, MD^*, Chihaya Koriyama, MD, Akira Kisanuki, MD^*, Shinichi Minagoe, MD^*, Robert A. Levine, MD, FACC and Chuwa Tei, MD, FACC^*

^* First Department of Internal Medicine, , Kagoshima, Japan
Department of Public Health, Kagoshima University School of Medicine, Kagoshima, Japan
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA

View larger version (28K): [in a new window]   Figure 1 Methods to quantitate the geometry of the mitral valve apparatus and left ventricle (LV) shape. D = short-axis dimension of LV; L = long-axis dimension of LV; LA = left atrium; RA = right atrium; RV = right ventricle.

View larger version (58K): [in a new window]   Figure 2 Lack of important incomplete mitral leaflet closure (IMLC) and mitral regurgitation (MR) in a patient with lone atrial fibrillation (AF), despite annular dilation (yellow arrows), compared with a patient with idiopathic or ischemic cardiomyopathy (ICM) showing moderate IMLC and MR. Longer papillary muscle tethering length (white arrows) in the patient with ICM restricts leaflet closure and induces IMLC and MR.

View larger version (36K): [in a new window]   Figure 3 Scatterplots showing correlations between the incomplete mitral leaflet closure (IMLC) area (upper panels) or percent mitral regurgitation (MR) fraction (lower panels) and the mitral annular area or sum of the papillary muscle (PM) tethering distance.