tee in anatomy of mitral valve
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inaechoTRANSCRIPT
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Transesophageal Echocardiography of Mitral Valve
M. Arif Nugroho, MD
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Introduction The mitral valve has triple function :
• Regulating blood to LV at low pressure, while preventing systolic backflow to LA
• Contributes LVOT formation on systolic phase
• Maintain normal size, geometry and function of Left Ventricle
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Components of Mitral Valve Five Components : -Annulus -Leaflets -Commisures -Chordae tendinea -Papillary muscles
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Mitral Valve Complex
Normal function of MV depends on complex interaction of MV components defined as “MV complex”
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Mitral Valve Morphology
Mitral Annulus
- The mitral annulus constitutes the anatomical junction between the LV and LA, it serves as insertion site for the leaflet tissue
- Oval and saddle shaped
- it’s a fibrotic ring that consists of an anterior part and posterior part
- The annulus is deficient anteriorly at he level of the aorto - mitral curtain
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Continued • The anterior portion of
mitral annulus is attached to the fibrous trigones and generally more developed than posterior ann.
• The aortic – mitral curtain is a fibrous structure that connects the anterior mitral annulus intimately with the aortic valve annulus (at the level of the left and NCC)
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MITRAL LEAFLETS
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Minor Axis
• An appropriate measurement of the minor axis (antero – posterior diameter) of the mitral annulus is performed at end systole during TTE in the apical long axis view ( 3 chamber view) or
• Its transesophageal equivalent, found at mid esophageal, with the probe tilted at 120-135o
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The Major Axis (inter commisural diameter)
• The major axis is found at a bicommisural two chamber TEE view
• It is when the P1 – A2 – P3 mitral leaflet scallops is visualized
• Or in a midesophageal bicommisural view at 45’-60’
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View of Minor and Major axises of MV
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Anatomic Classification Scheme: Mitral Valve Segments & Duran Classification
Duran Classification
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•Mid-esophageal 4C View
•A3 and A1
•Commisural View
•P3-A2-P1
•Two Chamber View
•P3-A1
•Long Axis View
•A2
•Transgastric Views (Short)
•Posteromedial commissure
•Anterolateral commissure
•Transgastric Views (Long)
•Chordae Tendinae
•Papillary Muscle
TEE Assessment of the Mitral Valve
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Cardiol Clin. 2000; 18: 731-50.
Four Chamber Views vs Two Chamber Views : Isolating Mitral Valve Leaflet Segments
Two Chamber Views: ↓
↑ Four Chamber Views:
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Mid-esophageal Views (Transducer @ 0°)
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Four Chamber View
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Crit Care Clin. 1996; 12: 321-81.
Two Chamber: Posterior View
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Apical Long Axis View
Cardiol Clin. 2000; 18: 731-50.
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Cardiol Clin. 2000; 18: 731-50.
Transgastric Long-axis View: Visualization of the Papillary Muscles
Posteromedial Papillary Muscle
Anterolateral Papillary Muscle
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