Andersons pediatric cardiology 1463
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▪MVchordae
▪Identificationofchordalelongation,rupture,chordalshortening,
andfusion
MV,Mitralvalve
ThemostcommonlyusedfunctionalclassificationofrheumaticMVdiseaseis
theCarpentierclassification.Thisclassificationisaimedatoptimizingsurgical
repairstrategiesformitralinsufficiencyandisdetailedinBox55.3.37
Box55.3
Carpentier'sFunctionalClassificationof
MitralValveInsufficiency
TypeI:Annulardilationwithnormalleafletmotion
TypeII:Leafletprolapse
TypeIIa/IIIp:Prolapseofanteriormitralvalveleafletandrestrictionof
posteriorleaflet
TypeIII:Restrictedleafletmotion
a,Anterior,p,posterior.
AorticValveDisease
TheearlydiseaseprocessischaracterizedbyAR,whichcanbeeccentric,with
leafletprolapseresultinginalossoftheheightofthecusptissueand
commissures(Fig.55.9A–B).38Withtimetheleafletsthicken,retract,andtheir
edgesroll,givingrisetoamixedhemodynamiceffect(stenosisand
regurgitation,Fig.55.9C).Overthecourseofdecades,calcificationofleaflets
occursprogressivelyandthependulumswingstowardapredominantlystenotic
hemodynamiceffect.Thisisextremelyrareinchildrenandadolescents.Thekey
elementsofAVassessmentbyechocardiographyarelistedinBox55.4.
FIG.55.9 Rheumaticheartdiseaseoftheaorticvalve.(A)
Transesophagealechocardiogram(TEE)inapatientwithmixedaorticand
mitralvalvedisease.Viewwasobtainedat115degreesandshows
prolapseoftherightcoronarycommissure.Thereisthickeningofthevalve
leafletedge.(B)TEEobtainedat56degreesshowingashort-axisviewof
theaorticvalve.Therightcoronarycusphasprolapsed,resultingina
centralareaofnoncoaptationthatresultsinaorticregurgitation.(C)
Parasternallong-axisviewshowingmarkedlythickenedaorticvalve
involvingbothrightandleftcoronarycusps.
Box55.4
KeyElementsintheEchocardiographic
AssessmentofAorticValveAnatomy
■AVannulus
■Measurementofdiameterandcomparisonwithnormalz-score
measurements
■AVleaflets
■Leafletheight
■Identificationandlocalizationofleafletprolapse
■Assessmentofleafletthickeningandcalcification
■Definitionofmechanismofdysfunction
