Quantification of tethering of mitral valve in ischemic MR

Quantification of tethering of mitral valve in ischemic MR

Quantification of tethering of mitral valve in ischemic MR: Both two dimensional and three dimensional echocardiography are useful in quantifying the tethering of mitral leaflets in ischemic mitral regurgitation (IMR).

Tenting area: 

Tenting area is measured by two dimensional echocardiography as the area from the mitral leaflets to the annular plane in mid systole.

Coaptation height / depth:

It is the maximal distance from the leaflet tips to the annular plane. Coaptation depth has been correlated with the severity of ischemic mitral regurgitation.

Tethering volume: 

Tethering volume is the volume from the leaflets to the annular plane, measured by three dimensional echocardiography.

Tethering distance: 

Tethering distance is the distance from the papillary muscle tip to the mitral annulus, measured by three dimensional echocardiography.

Tethering of mitral leaflets is secondary to dilatation of the left ventricle with outward displacement of papillary muscles [1].

Mitral regurgitation due to tethering has been classified into asymmetric group with predominant posterior tethering of both leaflets and a symmetric group with predominantly apical tethering of both leaflets [2].

References

1. Nozomi Watanabe , Yasuo Ogasawara, Yasuko Yamaura, Takahiro Kawamoto, Eiji Toyota, Takashi Akasaka, Kiyoshi Yoshida. Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography. J Am Coll Cardiol. 2005 Mar 1;45(5):763-9.
2. Eustachio Agricola, Michele Oppizzi, Francesco Maisano, Michele De Bonis, Arend F L Schinkel, Lucia Torracca, Alberto Margonato, Giulio Melisurgo, Ottavio Alfieri. Echocardiographic Classification of Chronic Ischemic Mitral Regurgitation Caused by Restricted Motion According to Tethering Pattern. Eur J Echocardiogr. 2004 Oct;5(5):326-34.