Andersons pediatric cardiology 1462
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FIG.55.6 (A)Leftatriumopenedtoshowthethickenedmitralvalvewitha
characteristicfishmouthopening.Theasteriskindicatesthemural
(posterior)leaflet.(B)Openedmitralvalvewithchronicrheumaticlesions
characterizedbyshortandthickcordsandfusionoftheendsofthezoneof
apposition.(FromGrinbergM,SampaioRO,editors.DoenỗaValvar.Sóo
Paulo,Brazil:EditoraManole,2006.)
FIG.55.7 Morphologicfeaturesofasurgicallyexcisedstenoticrheumatic
mitralvalve.(A)Atrialaspect,revealingthestenoticorificeandthickened
leaflets.(B)Ventricularaspect,withfusedtendinouscordsandobliteration
ofintercordalspaces.
InthesettingofRHD,theentireMVapparatusmustbeinterrogatedcarefully
toclarifythemechanismandnatureofvalvardysfunction.Theinternational
standardtodescribethesegmentsofanterior(A)andposterior(P)MVleaflets
dividestheseintoatotalofsixscallops:A1,A2,A3,andP1,P2,P3(Fig.55.8).
OntheanteriorMVleaflet,A1isthemostanteriorscallopandA3istheclosest
totheAV.36Eachsegmentmustbecarefullyinspected,asthediseaseprocess
mayinvolvedifferentsegmentsindifferentways,withsomeareashaving
restrictedandothersexcessiveleafletmotionbasedonthecomplexinterplayof
thechordalapparatus,leaflets,andannulus.Thekeyelementsof
echocardiographicevaluationoftheMVapparatusinRHDarelistedinBox
55.2.
FIG.55.8 Anatomyofthemitralvalve—leftatrialorsurgeon'sperspective.
Box55.2
KeyElementsintheEchocardiographic
AssessmentofMitralValveAnatomy
▪MVannulus
▪Measurementofannulardiameterandcomparisonwithnormalzscoremeasurements
▪MVleaflets
▪Evaluationofleafletmotionduringsystoleanddiastole
▪Identificationofscallopsofleafletsthatarerestrictedorhave
excessiveleafletmotionorprolapse
▪Quantificationofleafletthickeningandcalcification
▪PlanimetryoftheMVtomeasureeffectiveorifice
▪MVcommissures
▪Assessmentofdegreeofcommissurefusion/prolapse
