Introduction
Mitral regurgitation accompanies the heart failure with low ejection
fraction at the rate of 30-50% (1). The coexistence of functional
mitral regurgitation in patients with HfrEF is asscoiated with two fold
increase in the mortality rates.(2) Progressive remodelling occurring in
heart failure leads to left ventricular dilatation, increase in cavity
sphericity, annulus expansion and displacement of papillary muscles
result in improper coaptation of the leaflets and functional mitral
regurgition. (3)-(4)
Although improvement in the mitral regurgitaion is expected after CRT
implantation this is not the case in all of the patients. Several
parameters were evaluated for the prediction of improvement of mitral
regurgitation after CRT implantation by 2D echocardiography. Tenting
hight and interpapillary muscle distance were found to be related to
improvement (5).
3D TEE is an integral part of the imaging in mitral valve disesases and
has proven to be the most convincing method for understanding the
complicated anatomy of the mitral valve and its dynamism.In addition to
high quality real time imaging of the mitral valve it allows us to make
quantitaive measurements by post process analysis.
Impact of CRT on geometric changes in mital valve apparatus and
subvalvular structures and the parameters that would predict the
improvement of mitral regurgitation still remain to be elucidated.
The aim of the this study was to evaluate the geometric parameters of
mitral valve measured by three dimensional transosephageal
echocardiography prior to CRT which would predict the improvement of
mitral regurgitation after CRT implantation.