Cedars-Sinai Heart Institute, Los Angeles, California.
Cedars-Sinai Heart Institute, Los Angeles, California.
J Am Soc Echocardiogr. 2017 Dec;30(12):1162-1168. doi: 10.1016/j.echo.2017.06.019. Epub 2017 Aug 12.
Flail mitral leaflet is a common complication of degenerative mitral regurgitation (MR) and is generally equated with severe MR. However, a flail mitral leaflet is not always associated with severe MR. The hemodynamic and clinical significance of a flail leaflet in the absence of severe MR has not been characterized. The authors identified cases of flail mitral leaflet associated with only mild or moderate MR and evaluated their echocardiographic features and clinical outcomes.
The echocardiography database at Cedars-Sinai Medical Center was queried for reports of flail mitral valve leaflet. Cases of possible flail and ≤3+ MR were identified and adjudicated for the presence of definite flail and ≤2+ MR. These patients were retrospectively evaluated by chart review to determine clinical outcomes.
Seven hundred six cases of possible flail were identified, of which 143 were identified as having ≤3+ MR. Of these, 14 cases were identified with definitive echocardiographic evidence of a flail mitral leaflet and ≤2+ MR. Over a median of 361 days of follow-up, MR progressed in severity in only one patient, in association with endocarditis and death. All other patients were free of progression of MR, heart failure, or mortality during follow-up.
A flail mitral leaflet is not synonymous with severe MR and can be associated with only mild or moderate MR. Furthermore, patients with flail mitral leaflet and only mild to moderate MR were clinically stable. Thus, an integrated, multiparametric approach should be used to assess MR severity, even in the presence of a flail mitral leaflet.
连枷状二尖瓣瓣叶是退行性二尖瓣反流（MR）的常见并发症，通常等同于严重的 MR。然而，连枷状二尖瓣瓣叶并不总是与严重的 MR 相关。在没有严重 MR 的情况下，连枷瓣叶的血流动力学和临床意义尚未得到明确。作者确定了仅伴有轻度或中度 MR 的连枷状二尖瓣瓣叶的病例，并评估了其超声心动图特征和临床结局。
Cedars-Sinai 医疗中心的超声心动图数据库中检索了连枷状二尖瓣瓣叶的报告。确定了可能的连枷和≤3+MR 的病例，并对存在明确的连枷和≤2+MR 的病例进行了裁决。通过病历回顾对这些患者进行回顾性评估，以确定临床结局。
共确定了 706 例可能的连枷，其中 143 例被确定为≤3+MR。在这些病例中，有 14 例通过明确的超声心动图证据被确定为存在连枷状二尖瓣瓣叶和≤2+MR。在中位数为 361 天的随访期间，仅 1 例患者的 MR 严重程度进展，与心内膜炎和死亡相关。在随访期间，所有其他患者的 MR、心力衰竭或死亡率均无进展。
连枷状二尖瓣瓣叶并不等同于严重的 MR，也可能仅与轻度或中度 MR 相关。此外，存在连枷状二尖瓣瓣叶且仅有轻度至中度 MR 的患者临床情况稳定。因此，即使存在连枷状二尖瓣瓣叶，也应采用综合的多参数方法来评估 MR 的严重程度。
