DK2985_C000 1..28 - AlSharqia Echo Club

394 Transesophageal Echocardiography(A)(B)LAAoLVRVFigure 17.14 Mid-esophageal four-chamber view of a 53-year-old man with severe myxomatous thickening of both anterior and posteriormitral valve leaflets (Barlow’s disease) before mitral valve repair (Ao, aorta; LA, left atrium; LV, left ventricle; RV, right ventricle).dilatation, inadequate papillary muscle traction from myocardialischemia, excessive obtuse angulation betweenthe papillary muscle and the mitral annular plane, andsignificant alteration in left ventricular geometry inassociation with cavity dilatation. The MR is labeledfunctional, with a central jet where the leaflets are tetheredby outward displacement of the left ventricular walls andpapillary muscles, with or without concomitant annulardilatation. Similar MR mechanisms are also observedin advanced dilated cardiomyopathy of other etiologies(see Chapter 10).The prognosis of patients with IMR is substantiallyworse than regurgitation from other causes.1. Chordal RuptureOne of the most common causes of flail mitral valveis chordal rupture, often associated with mitral valveprolapse, endocarditis, trauma, or in the setting of acutemyocardial infarction (Figs. 17.16–17.20).E. Traumatic Mitral Valve InjuryThe most common cardiac injury seen after blunt chesttrauma is myocardial contusion. When cardiac valves areinvolved, the AoV is the most frequently damaged, followedby the mitral and tricuspid valves. The mitral(A)(B)P3LALVA3A2A1(C)A2A3Figure 17.15 A 58-year-old woman scheduled for mitral valve repair. As shown with the mid-esophageal two-chamber view, mitralregurgitation is secondary to a prolapsed anterior mitral leaflet (A2 and A3). (C) Intraoperative findings (LA, left atrium; LV, leftventricle). (Photo C courtesy of Dr. Michel Pellerin.)