Morphological characteristics of the regurgitant rheumatic mitral valve

Reparative surgery for valvular insufficiency is attempted frequently. The success of surgery depends partly on the underlying etiology. To establish the morphological characteristics of rheumatic mitral valve disease (insufficiency) (n = 12), mitral insufficiency due to infective endocarditis (n = 12), mitral insufficiency postinfarction (n = 6), rheumatic (predominant) mitral insufficiency postinfarction (n = 6), rheumatic (predominant) mitral stenosis (n = 12) and normal patients (n = 12) were examined retrospectively. In the groups of patients with mitral insufficiency< the mobility of the posterior leaflet tip (change in angle from the annular plane) was significantly less than normal 48 +/- 9 degrees only in the rheumatic group (12 +/- 7 degrees, P < 0.01). The posterior mitral leaflet tip had greater than normal mobility in the other mitral insufficiency groups: infective endocarditis 53 +/- 15 degrees (P = 0.35 versus normals), postinfarction 63 +/- 11 degrees (P = 0.02 versus normals), myxomatous 63 +/- 19 degrees (P = 0.03 versus normals). The mobility of the posterior mitral leaflet tip was also significantly less than normal in the rheumatic mitral stenosis group: 16 +/- 7 degrees, P < 0.01 versus normals. In the two rheumatic groups, diastolic doming of the anterior mitral leaflet was seen solely in mitral stenosis. In the predominant regurgitant group, the tip of the anterior mitral leaflet was much more mobile than in the stenosis group. Doming of the anterior mitral leaflet was absent from the predominant regurgitant group (2.1 +/- 0.9 cm, P < 0.001). The stenotic mitral valves domed 0.75 +/- 0.15 cm.(ABSTRACT TRUNCATED AT 250 WORDS)