Left ventricle assessment by three-dimensional HeartModel software in different types of mitral valve prolapse (Barlow’s disease and fibroelastic deficiency) with severe mitral regurgitation

Mitral valve prolapse (MVP) is the most common cause of isolated mitral regurgitation (MR) requiring surgical repair. Therapeutic interventions should be considered before irreversible left ventricular (LV) dysfunction in asymptomatic patients. Measurement of LV volume and function is very important. Because of two-dimensional (2D) echocardiography limitations, three-dimensional (3D) measurement is preferred on the strength of its speed, accuracy, and reproducibility, which are comparable with those of magnetic resonance imaging (MRI).

This study was conducted between April 2018 and February 2019 on 50 patients with different MVP types and severe MR scheduled for valve surgery at Rajaie Cardiovascular Research Center, Tehran, Iran, with the aid of the HeartModelAnatomical intelligence (A.I.) (EPIQ 7: new 3D software) for measurement of LV volume indices and function.

Patients with the Barlow syndrome had a greater drop in LV ejection fraction (LVEF) than those with fibroelastic deficiency (FED) (57.05% ± 6.00% vs. 65.00% ± 4.08%; P = 0.001). LV volume was larger in patients with flail mitral valve (MV) than in those with non-flail MV (165 cc vs. 118 cc; P = 0.001). LVEF declined more in patients with the involvement of both leaflets than in those with the involvement of the anterior leaflet alone (56.00% ± 7.10% vs. 57.70% ± 4.30%; P = 0.021).

The LVEF drop was more remarkable in patients with the Barlow syndrome (both flail and non-flail MV) than in those with FED. It is, therefore, advisable that such patients be monitored more meticulously via the 3D HeartModelA.I. method in terms of LVEF and LV size to prevent irreversible effects on LV function and to reduce mortality.