Mitral annulus morphometry in degenerative mitral regurgitation phenotypes

Giacomo Maria Viani, Laura Anna Leo, Maria Giuliana Borruso, Catherine Klersy, Vera Lucia Paiocchi, Susanne Anna Schlossbauer, Alessandro Caretta, Stefanos Demertzis, Francesco Fulvio Faletra

Research output: Contribution to journalArticlepeer-review


Objectives: Degenerative mitral regurgitation (DMR) is classified into different phenotypes based on the extent of leaflet degeneration. Our aim is to demonstrate that phenotype complexity predicts the extent of structural abnormalities of mitral annulus (MA). Methods and results: Seventy-five patients with DMR and severe valve regurgitation and 23 patients with normal mitral valve were studied using 3D transesophageal echocardiography. Classification of DMR was done by allocating each 3D echocardiography result under five categories: fibroelastic deficiency (FED), FED+, forme fruste, BD MAD– or BD MAD+. MA was reconstructed in early systole and in end systole. We tested for a trend toward enlargement and flattening of MA in end systole and for a difference in MA dynamics from early systole to end systole with a worsening of DMR phenotype, in the whole spectrum of subjects ranging from controls to BD MAD+. A significant trend was observed toward larger anteroposterior diameter, intercommissural diameter, annulus circumference, and annulus area (P <.001). A reduction was found in annulus height to commissural width ratio (P =.003): This indicates a progressive MA flattening. Prolapse height and prolapse volume tended to be larger (P <.001). Conclusion: Based on the extent of leaflet degeneration, DMR is classified into different phenotypes. As the disease progresses, a related increase in MA size is found, with rounder annular shape, loss of saddle shape, and increase in height and volume of leaflet prolapse. The most pronounced alterations are found in BD MAD+.

Original languageEnglish
Publication statusAccepted/In press - Jan 1 2020


  • mitral regurgitation
  • mitral valve
  • mitral valve prolapse
  • three-dimensional echocardiography
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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