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Echocardiographic examination of mitral valve abnormalities in the paediatric population: current practices

  • Massimiliano Cantinotti (a1), Raffaele Giordano (a2), Martin Koestenberger (a3), Inga Voges (a4), Giuseppe Santoro (a1), Eliana Franchi (a1), Nadia Assanta (a1), Israel Valverde (a5), John Simpson (a6) and Shelby Kutty (a7)...

Abstract

We reviewed the recent literature for echocardiographic assessment of mitral valve abnormalities in children. A literature search was performed within the National Library of Medicine using the keywords “mitral regurgitation and/or stenosis, children.” The search was refined by adding the keywords “echocardiographic definition, classification, and evaluation.” Thirty-one studies were finally included. Significant advances in echocardiographic imaging of mitral valve defects, mainly due to the implementation of three-dimensional technology, contribute to a better understanding of the underlying anatomy. However, heterogeneity between classification systems of mitral valve disease severity is a serious problem. For regurgitant lesions, there is only very limited evidence from small studies that support the adoption of quantitative/semi-quantitative indexes commonly employed in adults. Despite the lack of evidence base, qualitative evaluation of regurgitation severity is often employed. For stenotic lesions, no clear categorisation based on trans-valvular echocardiography-derived “gradients” has been consistently applied to define mild, moderate, or severe obstruction across different paediatric age ranges. Quantitative parameters such as valve area have also been poorly validated in children. Adult recommendations are frequently applied without validation for the paediatric age. In conclusion, significant advances in the anatomical evaluation of mitral valve diseases have been made, thanks to three-dimensional echocardiography; however, limitations remain in the quantitative/semi-quantitative estimation of disease severity, both with respect to valvular regurgitation and stenosis. Because adult echocardiographic recommendations should not be simply translated to the paediatric age, more specific paediatric guidelines and standards for the assessment of mitral valve diseases are needed.

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Corresponding author

Author for correspondence: R. Giordano, MD, PhD, Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy. Tel: +390817464702; Fax: +390817464702; E-mail: r.giordano81@libero.it

References

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1.Falk, V, Baumgartner, H, Bax, JJ, et al.ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52: 616664.
2.Bonow, RO, Carabello, BA, Kanu, C, et al.ACC/UAHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologist: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeon. Circulation 2006; 114: e84e231.
3.Lancellotti, P, Moura, L, Pierard, LA, et al.European Association of Echocardiography reccomnedations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010; 11: 307332.
4.Cantinotti, M, Scalese, M, Molinaro, S, Murzi, B, Passino, C. Limitations of current echocardiographic nomograms for left ventricular, valvular, and arterial dimension in children: a critical review. J Am Soc Echocardiogr 2012; 25: 142152.
5.Cantinotti, M, Lopez, L. Nomograms for blood flow and tissue Doppler velocities to evaluate diastolic function in children: a critical review. J Am Soc Echocardiogr 2013; 26: 126141.
6.Lopez, L, Colan, SD, Frommelt, PC, et al.Recommendation for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group pf the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465495.
7.Driscoll, D, Allen, HD, Atkins, DL, et al.Guidelines for evaluation and management of common congenital cardiac problems in infants, children, and adolescents. A statement forhealthcare professionals from the Committee on Congenital Cardiac Defects of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994; 90: 21802188.
8.Remenyi, B, Gentles, TM. Congenital mitral valve lesions: correlation between morphology and imaging. Ann Pediatr Cardiol 2012; 5: 312.
9.Seguela, PE, Houyel, L, Acar, P. Congenital malformations of the mitral valve. Arch Cardiovasc Dis 2011; 104: 465479.
10.Banerjee, A, Kohl, T, Silverman, NH. Echocardiographic evaluation of congenital mitral valve anomalies in children. Am J Cardiol 1995; 76: 12841291.
11.Carpentier, A, Branchini, B, Cour, JC, et al.Congenital malformations of the mitral valve in children: pathology and surgical treatment. J Thorac Cardiovasc Surg 1976; 72: 854856.
12.Collins-Nakai, RL, Rosenthal, A, Castaneda, AR, Bernhard, WF, Nadas, AS. Congenital mitral stenosis. A review of 20 years’ experience. Circulation 1977; 56: 10391047.
13.Mitruka, SN, Lamberti, JJ. Congenital heart surgery nomenclature and database projectol: mitral valve disease. Ann Thorac Surg 2000; 69 (4 Suppl.): S132S146.
14.Oppido, G, Davies, B, McMullan, DM, et al.Surgical treatment of congenital mitral valve disease: midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 2008; 135: 13131320.
15.Anderson, RH. When is the supravalvar mitral ring truly supravalvar? Cardiol Young 2009; 19: 1011.
16.Toscano, A, Pasquini, L, Iacobelli, R, et al.Congenital supravalvar mitral ring: an understimated anomaly. J Thorac Cardiovasc Surg 2009; 137: 538542.
17.Bano-Rodrigo, A, Van Praagh, S, Trowitzsch, E, et al.Double orifice mitral valve: a study of 27 postmortem cases with developmental, diagnostic and surgical considerations. Am J Cardiol 1988; 61: 152160.
18.Trowitzsch, E, Bano Rodrigo, A, Burger, B, et al.Two-dimensional echocardiographic finding in double orifice mitral valve. J Am Coll Cardiol 1985; 6: 383387.
19.Abdullah, M, Pearce, K, Palmer, N, Chenzbraun, A. Double orifice mitral valve with dysplastic tricuspid valve and intact interatrial septum: a three-dimensional echocardiographic study. Eur J Echocardiogr 2008; 9: 598599.
20.Matsushima, A, Park, J, Szule, M, et al.Anomalous atrioventricular valve arcade. Am Heart J 1991; 121: 18241826.
21.Kim, SJ, Shin, ES, Mk, Park, et al.Congenital mitral insufficiency caused by anomalous mitral arcade in an elderly patient: use of echocardiography and multidetector computed tomography for diagnosis. Circ J 2005; 69: 15601563.
22.Valverde, I, Rawlins, D, Austin, C, Simpson, JM. Three-dimensional echocardiography in the management of parachute mitral valve. Eur Heart J Cardiovasc Imaging 2012; 13: 446.
23.Bonow, RO, Cheitlin, MD, Crawford, MH, Douglas, PS. Task Force 3: valvular heart disease. J Am Coll Cardiol 2005; 45: 13341340.
24.Riggs, TW, Lapin, GD, Paul, MH, Muster, AJ, Berry, TE. Measurement of mitral valve orifice area in infants and children by two-dimensional echocardiography. J Am Coll Cardiol 1983; 1: 873878.
25.Prakash, A, Lacro, RV, Sleeper, LA, et al.Challenges in echocardiographic assessment of mitral regurgitation in children after repair of atrioventricular septal defect. Pediatr Cardiol 2012; 33: 205214.
26.Fernades, FP, Manlhiot, C, McCrindle, BW, Mertens, L, Kantor, PF, Friedberg, MK. 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.
27.Tunaoglu, FS, Olgunturk, R, Kula, S, Oguz, D. Effective regurgitant orifice area of rheumatic mitral insufficiency: response to angiotensin converting enzyme inhibitor treatment. Anadolu Kardiyol Derg 2004; 4: 37.
28.Aotsuka, H, Tobita, K, Hamada, H, et al.Validation of the proximal isovelocity surface area method for assessing mitral regurgiation in children. Pediatr Cardiol 1996; 17: 351359.
29.Baspinar, O, Karaaslan, S, Oran, B. PISA method for assessment of mitral regurgitation in children. Anadolu Kardiyol Derg 2005; 5: 167171.
30.Gabriel Lactu, D, Paranon, S, Bongard, V, et al.Quantification of mitral-valve regurgitation in a paediatruic population by real-time three-dimensional echocardiography. Arch Cardiovasc Dis 2008; 101: 697703.
31.Ziani, AB, Lactu, DG, Abadir, S, Paranon, S, Dulac, Y, Guerrero, F, Acar, P. Assessment of proximal isovelocity surface area (PISA) shape using three-dimensional echocardiography in a paediatric population with mitral regurgitation or ventricular shunt. Arch Cardiovasc Dis 2009; 102: 185191.
32.Acar, P, Laskari, C, Rhodes, J, Pandian, N, Warner, K, Marx, G. Three-dimensional echocardiographic analysis of valve anatomy as a determinant of mitral regurgitation after surgery for atrioventricular septal defects. Am J Cardiol 1999; 83: 745749.
33.Hlavacek Am, Crawford FA, Jr, Chessa, KS, Shirali, GS. Real-time three-dimensional echocardiography is useful in the evaluation of patients with atrioventricular septal defects. Echocardiography 2006; 23: 225231.
34.Tamura, M, Manahem, S, Bizard, C. Clinical features and management of isolated cleft mitral valve in childhood. J am Coll Cardiol 2000; 35: 7647670.
35.Ruschlhaupt, D, Bharati, S, Lev, M. Mitral valve malformation of Ebstein’s type in absence of corrected transposition. Am Heart J 1976; 38: 109112.
36.Freed, LA, Levy, D, Levine, RAet al.Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 1999; 341: 17.
37.Kamei, F, Nakahara, N, Yuda, , Kobayashi, N, Tsuchihabsahi, K, Shimamoto, K. Long-term-site-related differences in the progression and regression of the idiopathic mitral valve prolapse syndrome. Cardiology 1999; 91: 161168.
38.Babaoglu, K, Altun, G, Binnetoglu, KP. Wave dispersion and heart rate variability in children with mitral valve prolapse. Pediatr Cardiol 2011; 32: 449454.
39.Levine, RA, Stathogiannis, E, Newell, JB, Harrigan, P, Weyman, AE. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four-chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 1988: 10101019.
40.Van Der Ham, DP, De Vries, JK, Van Der Merwe, PL. Mitral valve prolapse: a study of 45 children. Cardiovasc J S Afr 2003; 14: 191194.
41.Mueller, GC, Stark, V, Steiner, K, et al.Impact of age and gender on cardiac pathology in children and adolescents with Marfan syndrome. Pediatr Cardiol 2013; 34: 991998.
42.Bairacharya, P, Bhatnagar, S, Pauliks, LB. Mitral valve diseases in Williams syndrome-case report and review of the literature. Echocardiography 2011; 28: E156E159.
43.Miglioranza, MH, Muraru, D, Mihaila, S, Haertel, JC, Iliceto, S, Badano, LP. Isolated anterior mitral valve leaflet cleft: 3D transthoracic echocardiography-guided surgical strategy. Arq Bras Cardiol 2015;104: e49e52.
44.Ricek, S.J. Three-dimensional echocardiography of congenital abnormalities of the left atrioventricular valve. Echo Res Pract 2015; 2: R13R24.
45.Séguéla, P-E, Dulac, Y, Acar, P. Double-orifice mitral valve assessed by two- and three-dimensional echocardiography in a newborn. Arch Cardiovasc Dis 2011; 104: 361362.
46.Simpson, J, Lopez, L, Acar, P, et al. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17: 10711097.
47.Valverde, I, Rawlins, D, Austin, C, Simpson, JM. Three-dimensional echocardiography in the management of parachute mitral valve. Eur Heart J Cardiovasc Imaging 2012; 13: 446.
48.Baird, CW, Marx, GR, Borisuk, M, Emani, S, del Nido, PJ. Review of congenital mitral valve stenosis: analysis, repair, techniques and outcomes. Cardiovasc Eng Technol 2015; 6: 167173.
49.Jolley, MA, Hammer, PE, Ghelani, SJ, et al. Three-dimensional mitral valve morphology in children and young adults with Marfan syndrome. J Am Soc Echocardiogr 2018; 31: 11681177.e1
50.Rallidis, LS, Voltyrakis, E, Vrettou, A, Filippatos, G, Paraskevaidis, I, Kremastinos, DT. Real-time 3-dimensional transesophageal echocardiography: precise evaluation of a rocking mitral annuloplasty ring. Circulation 2009; 119: e206e208.
51.Cantinotti, M, Giordano, R, Scalese, M, et al.Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children. J Cardiol 2016; 68: 288299.
52.Hayashi, T, Inuzuka, R, Ono, H, Kato, H. Echocardiographic assessment of prosthetic mitral valves in children. Echocardiography 2017; 34: 94101.
53.Cantinotti, M, Kutty, S, Franchi, E, et al. Pediatric echocardiographic nomograms: what has been done and what still needs to be done. Trends Cardiovasc Med 2017; 27: 336349.
54.Hasan, A, Parvez, A, Ajmal, MR. Patent foramen ovale – clinical significance. JIACM 2004; 5: 339344.
55.Okada, Y, Inoue, N, Fukushima, N, et al. Idiopathic mitral valve chordae rupture in an infant: importance of rapid diagnosis and surgery. Pediatr Int 2015; 57: e65e68.
56.Calkoen, EE, Westenberg, JJ, Kroft, LJ, et al. Characterization and quantification of dynamic eccentric regurgitation of the left atrioventricular valve after atrioventricular septal defect correction with 4D Flow cardiovascular magnetic resonance and retrospective valve tracking. J Cardiovasc Magn Reson 2015; 17: 18.
58.Williams, K, Thomson, D, Seto, I, et al.; StaR Child Health Group. Standard 6: age groups for pediatric trials. Pediatrics 2012; 129 (Suppl 3): S153S160.

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Echocardiographic examination of mitral valve abnormalities in the paediatric population: current practices

  • Massimiliano Cantinotti (a1), Raffaele Giordano (a2), Martin Koestenberger (a3), Inga Voges (a4), Giuseppe Santoro (a1), Eliana Franchi (a1), Nadia Assanta (a1), Israel Valverde (a5), John Simpson (a6) and Shelby Kutty (a7)...

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