Division of Cardiology, Mount Sinai Morningside, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, New York
Address for correspondence:Dr. Roberto Ramirez, Mount Sinai Heart, Mount Sinai Morningside, Icahn
School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, New
York 10025.
Email: rhramirezmarmolejo@gmail.com
No conflicts of interest to disclose.
Case 1.
An 82-year-old man with history of ischemic cardiomyopathy and multiple
admissions due to acute decompensated heart failure was evaluated for
moderate to severe secondary MR due to atrial dilation (atrial
functional MR). TTE showed severe biatrial enlargement with a left
atrial volume of 117mL and a left atrial volume index of 65.5ml/m2. It
also showed LV of normal size, left ventricular LVIDd of 4.5cm and LVEF
of 55%. En face view revealed two central jets arising from the
coaptation gaps between posterior mitral leaflet indentations (P1/P2 and
P2/P3) (Figure A; Video A). (Figure B; Video B) Transillumination
rendering on 3D TEE, highlighted two distinct coaptation gaps between
posterior mitral leaflet scallops.
Case 2.
A 63-years-old woman with medical history of ischemic cardiomyopathy and
heart failure with reduced ejection fraction (35%) was evaluated for
moderate to severe secondary MR. TTE showed the LV dilation with LVIDd
of 5.7cm. TEE revealed severe eccentric MR. (Figure C; Video C) 3D color
Doppler TEE imaging of the mitral valve showed a severe regurgitant jet,
originated in-between P2 and P3 posterior scallops. (Figure D; Video D)
Transillumination rendering on 3D TEE, view from left atrium, in systole
highlighted the coaptation gap. (Figure E; Video E) 3D color Doppler TEE
imaging showed residual mild MR after a mitral clip was deployed
grasping the medial aspect of P2 and A2 scallops covering the coaptation
defect. (Figure F; Video F) Transillumination rendering on 3D TEE, view
from LV, showed complete resolution of the coaptation gap between
posterior scallops after clip deployment.