Mitral valve geometry in paediatric rheumatic mitral regurgitation

Area of Science:

• Cardiology
• Pediatric Cardiology
• Rheumatic Heart Disease

Background:

• Rheumatic mitral valve disease involves valvulitis and regurgitation, but its impact on mitral valve geometry and function is poorly understood.
• Childhood rheumatic heart disease can lead to significant mitral regurgitation, affecting cardiac structure and function.

Purpose of the Study:

• To assess mitral valve annulus remodeling in children with rheumatic mitral valve regurgitation.
• To investigate the effects of rheumatic process on mitral valve geometry and function.

Main Methods:

• 16 children (aged 6-15) with rheumatic mitral regurgitation (mild/moderate or severe) and 7 healthy controls underwent 3D echocardiography.
• 3D mitral valve geometry was analyzed using a Tomtec system to assess annular remodeling, saddle shape, and dimensions.

Main Results:

• The mitral valve lost its characteristic saddle shape in all rheumatic patients, indicated by increased non-planar angles.
• Annular area significantly increased in severe mitral regurgitation cases, while perimeter remained unchanged, suggesting leaflet effacement.
• Mitral valve area correlated strongly with left ventricular size.

Conclusions:

• Mitral valve apparatus remodeling in childhood rheumatic heart disease leads to abnormal annular geometry and loss of saddle shape, irrespective of regurgitation severity.
• Annular area enlargement is linked to leaflet effacement, severity of mitral regurgitation, and left ventricular size.
• These geometric changes are likely consequences of inflammation affecting the mitral annulus.