Morphometric analysis of mitral valve in barlow’s disease according to data of 3d transesophageal echocardiography and mitral valve quantification analysis

The aim of this study was to perform comprehensive morphometric quantitative analysis of the mitral valve (MV) in patients with Barlow’s disease (BD) by using the new noninvasive method for quantitative real-time three-dimensional (3D) transesophageal echocardiography (TEE) and mitral valve quantification (MVQ) analysis depending on age and gender. 3D TEE assessment of MV was performed in 33 BD patients aged 52.32+10.27 years with the degree of mitral regurgitation (MR) grade 3-4. Comparison group included 16 patients with intact MV at the age of 55.56+6.40 years. The diagnosis of BD was verified via the intraoperative revision in 31 cases (93.93%). All patients received TEE in standard mode. Off-line quantitative morphometric analysis of MV was performed by using the MVQ-analysis. Data showed that patients with BD had excessive redundancy and thickened and lengthened mitral valve leaflets leading to the multisegment prolapse of both leaflets with the loss of normal segmental anatomy of the MV as compared with patients who had intact MV. The phenomenon of “cul-de-sac” was observed in all patients with BD. The development of remodeling of the fibrous ring of Mv was caused by annular ectasia, increased anteroposterior and intercommissural diameters, as well as the increased perimeter and height of the ring. Analysis of the relationships between MR volume, assessed by 2D TEE, and quantitative morphometric parameters of MV showed associations between the MR volume, area (r=0.35; p=0.04), and the length of the anterior mV leaflet (r=0.36; p=0.03) in BD patients. Vena contracta width correlated with the front leaf area of MC (r=0.37; p=0.03) and posteromedial chord length (r=0.41; p=0.01). Data showed that quantitative morphometric parameters of MV leaflets and annulus fibrosus did not differ between men and women with BD. The left ventricular volume during diastole and systole correlated with indicators of the state of the MV leaflets, annulus fibrosus geometry, and the length of coaptation and chord.