Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography

Cardiovascular Ultrasound

Research

Giovanni Pulignano¹  Carla Clotilde Manzara¹  Giovanni Minardi¹  Paolo Giuseppe Pino¹  Stefania Leonetti²  Andrea Madeo³  Giulio Giuseppe Stefanini³  Francesco Musumeci³  Giuseppe Nicola Viceconte³  Carlo Gaudio³ 

[1] Department of Cardiovascular Science, "S Camillo-Forlanini" Hospital, Rome, Italy;Department of Cardiovascular Science, "S Camillo-Forlanini" Hospital, Rome, Italy;Heart and Great Vessels Department "Attilio Reale", Sapienza University of Rome, Italy;Heart and Great Vessels Department "Attilio Reale", Sapienza University of Rome, Italy;

关键词: Mitral Valve;    Mitral Regurgitation;    Mitral Valve Prolapse;    Anterior Leaflet;    Mitral Annular Calcification;   

DOI  :  10.1186/1476-7120-8-1

 received in 2009-10-16, accepted in 2010-01-01,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThis study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR).MethodsSeventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR), including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed.ResultsOut of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%), 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity). Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic accuracy). None of the 8 non-concordant 2D-TTE reports were in complete disagreement with SR. P2 scallop was always involved in posterior leaflet prolapse or flail and was described correctly by 2D-TTE in 68 out of 69 patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior leaflet was involved in 14 patients (18%); A2 segment was involved in all of those cases and was correctly detected by 2D-TTE in 13 (98,7% agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial para-commissural prolapse or flail had a lower prevalence (14% and 10% respectively), with 2D-TTE sensitivity respectively of 64% and 50%.Conclusions2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2), which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases.

【 授权许可】

CC BY   
© Minardi et al; licensee BioMed Central Ltd. 2010