Weissman N J, Pini R, Roman M J, Kramer-Fox R, Andersen H S, Devereux R B
Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021.
Am J Cardiol. 1994 Jun 1;73(15):1080-8. doi: 10.1016/0002-9149(94)90287-9.
Mitral leaflet morphology in mitral valve prolapse (MVP) has been suggested to be prognostically important, but in vivo valvular morphology is incompletely described in patients with MVP or in normal subjects. Accordingly, the length of both mitral leaflets and their zone of apposition, the thickness of their rough and clear zones, diastolic and systolic mitral annular diameters, and indexes of abnormal leaflet motion were measured in the parasternal long-axis echocardiographic view in 100 patients with MVP and 100 age- and sex-matched normal subjects. In both groups posterior leaflet thickness was related to age, as were anterior leaflet thickness and posterior leaflet length in patients with MVP. Compared with normal subjects, MVP patients without mitral regurgitation had thickened leaflets, elongated anterior leaflets, and large annular diameters (p < 0.0001). Patients with severe regurgitation had thicker leaflets, longer posterior leaflet and annular dimensions, and more abnormal leaflet motion than MVP patients without regurgitation. Leaflet thicknesses of different zones were supranormal in 60% to 67% and in 49% to 59% of MVP patients with and without severe regurgitation, respectively. MVP patients with regurgitation also had higher prevalences of abnormal mitral annular diameter than those without regurgitation (67% vs 29%) and > 3 mm posterior leaflet billowing into the left atrium (60% vs 34%). Thus, mitral valve size and leaflet thickness are increased in MVP patients without as well as with clinically important mitral regurgitation. The usefulness of leaflet thickening as a marker of severe MVP is limited by its high prevalence in patients with clinically mild MVP.
二尖瓣脱垂（MVP）患者的二尖瓣叶形态被认为具有重要的预后意义，但MVP患者或正常受试者的体内瓣膜形态尚未得到完整描述。因此，在100例MVP患者和100例年龄及性别匹配的正常受试者中，通过胸骨旁长轴超声心动图测量了二尖瓣叶的长度及其贴合区、粗糙区和透明区的厚度、二尖瓣环舒张期和收缩期直径以及瓣叶异常运动指数。在两组中，后叶厚度均与年龄相关，MVP患者的前叶厚度和后叶长度也与年龄相关。与正常受试者相比，无二尖瓣反流的MVP患者瓣叶增厚、前叶伸长且瓣环直径增大（p<0.0001）。重度反流患者比无反流的MVP患者瓣叶更厚、后叶和瓣环尺寸更长，且瓣叶运动异常更多。在有和无重度反流的MVP患者中，不同区域的瓣叶厚度分别有60%至67%和49%至59%超过正常范围。有反流的MVP患者二尖瓣环直径异常的患病率也高于无反流患者（67%对29%），且后叶膨入左心房>3mm的患病率更高（60%对34%）。因此，在无临床显著二尖瓣反流以及有临床显著二尖瓣反流的MVP患者中，二尖瓣大小和瓣叶厚度均增加。瓣叶增厚作为重度MVP标志物的有用性受到其在临床轻度MVP患者中高患病率的限制。
