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Updated: Mar 16, 2026

An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Pattern of Mitral Leaflet Elongation and Its Association With Functional Mitral Regurgitation in Nonischemic Dilated
Yu Kang1, Chen Chen1, Xiaojing Chen1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Abstract:
Adaptive enlargement of the mitral leaflet has been implied to participate in the pathogenesis of functional mitral regurgitation (FMR). The aim of the present study was to observe the elongation pattern of anterior mitral leaflets (AML) and posterior mitral leaflets (PML) in idiopathic dilated cardiomyopathy (DC) and to explore its relation with FMR. Forty normal controls (control group) and 97 patients with idiopathic DC (group DC 0-1+: 36 patients with no or only mild FMR; group DC >1+: 61 patients with more-than-mild FMR) were consecutively recruited. The lengths of AML and PML were measured at the parasternal long-axis view (AML-lax, PML-lax) and apical 4-chamber view (AML-4, PML-4) using 2-dimensional echocardiography, as well as tenting height (TH) and mitral annular dimension (MAD). Both AML (AML-lax: 2.4 ± 0.3 vs 3.0 ± 0.3 vs 3.1 ± 0.3 cm; AML-4: 1.9 ± 0.2 vs 2.5 ± 0.3 vs 2.6 ± 0.4 cm) and PML (PML-lax: 1.3 ± 0.3 vs 2.1 ± 0.5 vs 2.5 ± 0.4 cm; PML-4: 1.1 ± 0.2 vs 1.6 ± 0.3 vs 1.8 ± 0.4 cm) were elongated in the DC groups compared to controls (all p <0.001). There was a further elongation of PML in group DC >1+ than in group DC 0-1+ (p <0.05), but the AML length was not different (p >0.05). The ratio of (AML-lax + PML-lax)/(TH-lax + MAD-lax) (1.03 ± 0.10 vs 1.08 ± 0.09, p <0.05) or AML-lax/(TH-lax + MAD-lax) (0.57 ± 0.06 vs 0.64 ± 0.08, p <0.001) in group DC >1+ was significantly smaller compared to group DC 0-1+, whereas the ratio of PML-lax/(TH-lax + MAD-lax) was similar between the 2 groups (0.46 ± 0.06 vs 0.44 ± 0.07, p = 0.138). In conclusion, both the AML and PML were elongated in idiopathic DC, but the extent and pattern were not identical between the 2 leaflets. Inadequate AML elongation proportional to mitral apparatus remodeling more likely contributes to the pathogenesis of FMR.
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