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Clinical implications of mitral valve geometric alterations in children with dilated cardiomyopathy

Published online by Cambridge University Press:  28 December 2015

Taiyu Hayashi*
Affiliation:
Division of Cardiology, National Center for Child Health and Development, The University of Tokyo, Tokyo, Japan
Ryo Inuzuka
Affiliation:
Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Takahiro Shindo
Affiliation:
Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Hiroshi Ono
Affiliation:
Division of Cardiology, National Center for Child Health and Development, The University of Tokyo, Tokyo, Japan
Yukihiro Kaneko
Affiliation:
Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan
Hitoshi Kato
Affiliation:
Division of Cardiology, National Center for Child Health and Development, The University of Tokyo, Tokyo, Japan
*
Correspondence to: T. Hayashi, MD, National Center for Child Health and Development, Division of Cardiology, 2-10-1 Okura, Setagaya-ku, Tokyo 1578535, Japan. Tel: +81 3 3416 0181; Fax: +81 3 3416 2222; E-mail: taiyuhayashi@gmail.com

Abstract

We aimed to elucidate the relationship between severity of secondary mitral regurgitation and mitral valve geometry in children with dilated cardiomyopathy. The medical records of 16 children with dilated cardiomyopathy (median age, 1.2 years; range, 0.4–12.3 years) were reviewed. Mitral valve geometry was evaluated by measuring coaptation depth using echocardiographic apical four-chamber views at the initial presentation. Patients were dichotomised according to the mitral regurgitation severity: patients with moderate or severe secondary mitral regurgitation (n=6) and those with mild secondary mitral regurgitation (n=10). A total of 58 healthy children were considered as normal controls, and a regression equation to predict coaptation depth by body surface area was derived: coaptation depth [mm]=4.37+1.34×ln (body surface area [m2]) (residual standard error, 0.49; adjusted R2, 0.68; p<0.0001). Compared with patients with mild secondary mitral regurgitation, those with moderate or severe secondary mitral regurgitation had significantly larger coaptation depth z-scores (6.4±2.3 versus 1.9±1.4, p<0.005), larger mitral annulus diameter z-scores (3.6±2.6 versus 0.9±1.8, p<0.05), higher left ventricular sphericity index (0.89±0.07 versus 0.79±0.06, p<0.005), and greater left ventricular fraction shortening (0.15±0.05 versus 0.09±0.05, p<0.05). In conclusion, geometric alteration in the mitral valve and the left ventricle is associated with the severity of secondary mitral regurgitation in paediatric dilated cardiomyopathy, which would provide a theoretical background to surgical intervention for secondary mitral regurgitation in paediatric populations.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

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References

1. Towbin, JA, Lowe, AM, Colan, SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 2006; 296: 18671876.Google Scholar
2. Fernandes, FP, Manlhiot, C, McCrindle, BW, et al. Usefulness of mitral regurgitation as a marker of increased risk for death or cardiac transplantation in idiopathic dilated cardiomyopathy in children. Am J Cardiol 2011; 107: 15171521.Google Scholar
3. Patange, A, Thomas, R, Ross, RD. Severity of mitral regurgitation predicts risk of death or cardiac transplantation in children with idiopathic dilated cardiomyopathy. Pediatr Cardiol 2014; 35: 232238.Google Scholar
4. Breinholt, JP, Fraser, CD, Dreyer, WJ, et al. The efficacy of mitral valve surgery in children with dilated cardiomyopathy and severe mitral regurgitation. Pediatr Cardiol 2008; 29: 1318.Google Scholar
5. Walsh, MA, Benson, LN, Dipchand, AI, et al. Surgical repair of the mitral valve in children with dilated cardiomyopathy and mitral regurgitation. Ann Thorac Surg 2008; 85: 20852088.Google Scholar
6. Sugiyama, H, Hoshiai, M, Naitoh, A, et al. Outcome of non-transplant surgical strategy for end-stage dilated cardiomyopathy in young children. Circ J 2009; 73: 10451048.Google Scholar
7. Otsuji, Y, Handschumacher, MD, Schwammenthal, E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 1997; 96: 19992008.Google Scholar
8. Lee, AP, Acker, M, Kubo, SH, et al. Mechanisms of recurrent functional mitral regurgitation after mitral valve repair in nonischemic dilated cardiomyopathy: importance of distal anterior leaflet tethering. Circulation 2009; 119: 26062614.Google Scholar
9. Maréchaux, S, Pinçon, C, Poueymidanette, M, et al. Elevated left atrial pressure estimated by Doppler echocardiography is a key determinant of mitral valve tenting in functional mitral regurgitation. Heart 2010; 96: 289297.Google Scholar
10. Calafiore, AM, Gallina, S, Di Mauro, M, et al. Mitral valve procedure in dilated cardiomyopathy: repair or replacement? Ann Thorac Surg 2001; 71: 11461152.Google Scholar
11. Magne, J, Pibarot, P, Dagenais, F, et al. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation 2007; 115: 782791.Google Scholar
12. Cantinotti, M, Scalese, M, Murzi, B, et al. Echocardiographic nomograms for ventricular, valvular and arterial dimensions in Caucasian children with a special focus on neonates, infants and toddlers. J Am Soc Echocardiogr 2014; 27: 179191.Google Scholar
13. Kampmann, C, Wiethoff, CM, Wenzel, A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667672.Google Scholar
14. Daubeney, PE, Blackstone, EH, Weintraub, RG, et al. Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Cardiol Young 1999; 9: 402410.Google Scholar
15. Zoghbi, WA, Enriquez-Sarano, M, Foster, E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777802.Google Scholar
16. The Japanese Society for Pediatric Endocrinology. Stature-for-age and weight-for-age percentiles for Japanese children. 2000. Retrieved March 25, 2015, from http://jspe.umin.jp/medical/files/fuhyo2.pdf.Google Scholar
17. Grigioni, F, Enriquez-Sarano, M, Zehr, KJ, Bailey, KR, Tajik, AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 2001; 103: 17591764.Google Scholar
18. Koelling, TM, Aaronson, KD, Cody, RJ, Bach, DS, Armstrong, WF. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002; 144: 524529.Google Scholar
19. Trichon, BH, Felker, GM, Shaw, LK, Cabell, CH, O’Connor, CM. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003; 91: 538543.Google Scholar
20. De Bonis, M, Lapenna, E, Verzini, A, et al. Recurrence of mitral regurgitation parallels the absence of left ventricular reverse remodeling after mitral repair in advanced dilated cardiomyopathy. Ann Thorac Surg 2008; 85: 932939.Google Scholar
21. De Bonis, M, Ferrara, D, Taramasso, M, et al. Mitral replacement or repair for functional mitral regurgitation in dilated and ischemic cardiomyopathy: is it really the same? Ann Thorac Surg 2012; 94: 4451.Google Scholar
22. Rusconi, P, Gómez-Marín, O, Rossique-González, M, et al. Carvedilol in children with cardiomyopathy: 3-year experience at a single institution. J Heart Lung Transplant 2004; 23: 832838.Google Scholar
23. Gogoladze, G, Dellis, SL, Donnino, R, et al. Analysis of the mitral coaptation zone in normal and functional regurgitant valves. Ann Thorac Surg 2010; 89: 11581161.Google Scholar
24. He, S, Lemmon, JD Jr, Weston, MW, et al. Mitral valve compensation for annular dilatation: in vitro study into the mechanisms of functional mitral regurgitation with an adjustable annulus model. J Heart Valve Dis 1999; 8: 294302.Google Scholar
25. Kanzaki, H, Bazaz, R, Schwartzman, D, et al. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. J Am Coll Cardiol 2004; 44: 16191625.Google Scholar
26. Silbiger, JJ, Bazaz, R. Contemporary insights into the functional anatomy of the mitral valve. Am Heart J 2009; 158: 887895.Google Scholar
27. Song, JM, Kim, JJ, Ha, TY, et al. Basal chordae sites on the mitral valve determine the severity of secondary mitral regurgitation. Heart 2015; 101: 10241031.Google Scholar