Modified Carpentier functional classification of mitral valve disease

Modified Carpentier functional classification of mitral valve disease

Modified Carpentier functional classification of mitral valve disease: Carpentier in 1983 described a classification, mainly for mitral regurgitation, from the point of view of surgical repair [1]. It took into account the etiology, pathology and pathophysiology of mitral valve dysfunction. Initial classification had classes I-III with subclasses while classes IV and V were added later [2].

In type I, motion of leaflet margin is normal while there is prolapse or flail leaflet in type II. In type IIIa there is restricted leaflet opening while type IIIb has restricted leaflet closure. Type IVa has systolic anterior motion and type V has features of more than one of the other types. Type I occurs in valve leaflet perforation associated with infective endocarditis. Type II is the pattern seen in mitral valve prolapse. Restrictive opening in type IIIa is the hallmark of rheumatic mitral valve disease and is due to commissural fusion. Type IIIb with defective leaflet closure can be secondary to myocardial infarction or dilated cardiomyopathy. Systolic anterior motion (SAM) in type IVa is characteristic of hypertrophic cardiomyopathy. Combination of rheumatic valvular disease with a perforation induced by infective endocarditis is a typical hybrid condition qualifying for type V.

References

  1. A Carpentier. Cardiac Valve Surgery–The “French Correction”. J Thorac Cardiovasc Surg. 1983 Sep;86(3):323-37.
  2. Lotte E de Groot-de Laat, Jackie McGhie, Ben Ren, René Frowijn, Frans B Oei, Marcel L Geleijnse. A Modified Echocardiographic Classification of Mitral Valve Regurgitation Mechanism: The Role of Three-dimensional Echocardiography. J Cardiovasc Imaging. 2019 Jul;27(3):187-199.