Geometric deformations in mitral apparatus quantifiable by 3DE. A morphological understanding of the derangements in the mitral valve apparatus could guide the reconstructive approach. (A) Volumetric reconstruction depicting a normal saddle-shaped mitral annulus (yellow with green stripes; arrows) with preserved annular-papillary muscle (red; dashed arrows) anatomic relationship. (B) Mitral valve with prolapsing leaflets (P1, P2) demonstrating increased planarity and annular dimensions. (C) Mitral valve in ischemic cardiomyopathy depicting a funnel-shaped deformity (loss of saddle-shape), displacement of the coaptation zone, and increase in annulus-to-papillary muscle tethering length. (D) Mitral valve in a nonischemic cardiomyopathy patient. Volumetric reconstruction demonstrates similarly the funnel-shaped deformity with severe bilateral displacement of the papillary muscles mediolaterally and posteriorly quantified as tenting volume and angle.
Original figure modified for this publication. From: Lang RM, Tsang W, Weinert L, et al. Valvular heart disease: Value of three-dimensional echocardiography. J Am Coll Cardiol 2011; 58:1993. Illustration used with the permission of Elsevier Inc. All rights reserved.
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