Mitral valve

 

 

Anatomy

The mitral valve consists of two leaflets, the anterior (A) and the posterior valve leaflet (P), which together have a surface area of 4-6cm². At the inner edges of the leaflets chordae tendinae are attached, which ensure that the leaflets did not prolapse back into the atria during systole. The chordae attach to two large papillary muscles, that are part of the muscular tissue of the left ventricle.

The mitral valve can be visualized in many views: PLAX, PSAXmv, AP4Ch, AP5Ch, AP2Ch, AP3Ch and subcostaal4Ch. A prolapse of the MV is best assessed on PLAX. However, mitral regurgitation should be assessed in all views. In case of major abnormalities of the mitral valve 3D TOE has additional value in assessing the anatomy and function.

 

Ruptured mitral chordae tendineae assessed with 3D TOE

 

MV scallop partition
MVscallops

 

Regurgitation

 

Quantification of mitral valve regurgitation
Parameter Gering Matig Ernstig
Jetoppervlak/LA (%) <20 20-40 >40
Jetoppervlak (cm²) <4 4-10 >10
ERO (mm²) <20 20-40 >40
Vena contracta (mm) <3 3-7 >7

 

Severe MR because of prolaps

 

Causes of mitral valve regurgitation
Annulus dilatatie Degeneratie Verworven klepafwijking Secundair
Atriumfibrillatie Malcoaptatie bij mitralisklepsteonose Billowing Ritmestoornissen (LBTB-->diastolische MI)
Linkerventrikel dilatatie Prolaps SAM bij HCM
Linkeratrium dilatatie Floppy valve
Flail
Chordaruptuur
Papillairspierruptuur

 

Stenosis

 

Quantification of mitral stenosis
Parameter Gering Matig Ernstig
MVA (cm²) >1.5 1.5-1.0 <1.0
PGmean (mmHg) <5 5-10 >10
PHT (m/s) <90 90-150 >150

 

Causes of mitral stenosis
Acquired Tumor Congenital
Degeneracy Myxoma Parachute valve
Rheumatic fever Cor triatriatum sinistrum

 

Severe MS because of degeneration

 

Pane D

Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas.

 

 

 

 

 

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