Value of quantitative analysis of mitral regurgitation jet eccentricity bycolor flow Doppler for identification of flail leaflet

Early surgical intervention improves the outcome of patients with mitral re gurgitation (MR) secondary to flail leaflet. Current criteria for the diagn osis of flail leaflet require a detailed definition of mitral valve anatomy , which is often challenging by transthoracic echocardiography (TTE) and, o ccasionally, even by transesophageal echocardiography (TEE). We studied 57 patients (mean age 63 +/- 15 years) with anatomically confirmed flail mitra l leaflet and a control group of 57 patients (mean age 68 +/- 14 years) wit h at least moderate MR but no flail leaflet. In patients with flail mitral leaflet, the mean angle formed by the axis of the MR jet and the plane of t he mitral annulus was 33 +/- 11 degrees and 29 +/- 16 degrees when measured with TTE and TEE, respectively. In controls the mean angle was 66 +/- 16 d egrees and 66 +/- 17 degrees by TTE and TEE, respectively (p <0.0001). Base d on receiver-operating characteristic analysis, the optimal cutoff jet ang le value for diagnosing flail mitral leaflet was 45 degrees with TTE (sensi tivity 88%, specificity 88%), and 47 degrees by TEE (sensitivity 88%, speci ficity 88%). MR jet angles less than or equal to 45 degrees were also corre ctly identified by visual assessment of TTE images in > 90% of cases, with good interobserver agreement (k = 0.76). Thus, quantitative analysis of MR jet eccentricity by color flow Doppler is highly sensitive and specific for diagnosing flail mitral leaflet. (C) 2001 by Excerpta Medica, Inc.