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Insights into Functional Mitral Regurgitation Using Transillumination Rendering
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  • Roberto Ramirez,
  • Richard Ro,
  • Stamatios Lerakis,
  • Edgar Argulian
Roberto Ramirez
Mount Sinai Morningside Hospital
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Richard Ro
Mount Sinai Roosevelt Hospital
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Stamatios Lerakis
Mount Sinai Medical Center
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Edgar Argulian
Mt Sinai Sch Med
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Abstract

Case 1. An 82-year-old man with history of ischemic cardiomyopathy and multiple admissions due to acute decompensated heart failure was evaluated for moderate to severe secondary MR due to atrial dilation (atrial functional MR). TTE showed severe biatrial enlargement with a left atrial volume of 117mL and a left atrial volume index of 65.5ml/m2. It also showed LV of normal size, left ventricular LVIDd of 4.5cm and LVEF of 55%. En face view revealed two central jets arising from the coaptation gaps between posterior mitral leaflet indentations (P1/P2 and P2/P3) (Panel A). (Panel B) Transillumination rendering on 3D TEE, highlighted two distinct coaptation gaps between posterior mitral leaflet scallops. Case 2. A 63-years-old woman with medical history of ischemic cardiomyopathy and heart failure with reduced ejection fraction (35%) was evaluated for moderate to severe secondary MR. TTE showed the LV dilation with LVIDd of 5.7cm. TEE revealed severe eccentric MR. (Panel C) 3D color Doppler TEE imaging of the mitral valve showed a severe regurgitant jet, originated in-between P2 and P3 posterior scallops. (Panel D) Transillumination rendering on 3D TEE, view from left atrium, in systole highlighted the coaptation gap. (Panel E) 3D color Doppler TEE imaging showed residual mild MR after a mitral clip was deployed grasping the medial aspect of P2 and A2 scallops covering the coaptation defect. (Panel F) Transillumination rendering on 3D TEE, view from LV, showed complete resolution of the coaptation gap between posterior scallops after clip deployment.

Peer review status:ACCEPTED

03 Dec 2020Submitted to Echocardiography
03 Dec 2020Submission Checks Completed
03 Dec 2020Assigned to Editor
15 Dec 2020Reviewer(s) Assigned
05 Feb 2021Review(s) Completed, Editorial Evaluation Pending
08 Feb 2021Editorial Decision: Revise Major
21 Feb 20211st Revision Received
22 Feb 2021Submission Checks Completed
22 Feb 2021Assigned to Editor
22 Feb 2021Reviewer(s) Assigned
03 Mar 2021Review(s) Completed, Editorial Evaluation Pending
05 Mar 2021Editorial Decision: Accept