PMC10129252_01
A. Transthoracic apical four chamber view showing massive left atrium (LA) dilatation with LA volume of 1134 mL; B. Transthoracic apical four chamber view with color Doppler on the mitral valve and the LA showing severe mitral regurgitation; C. Transesophageal three-dimensional image of the mitral valve (atrial view) at mid-systole showing a coaptation gap between the two leaflets (arrowheads); D. Similar to panel C but ventricular view (arrowheads); E. Transesophageal four chamber view (0 ), zoomed on the mitral valve, at mid-systole, showing the coaptation gap with leaflet restriction (posterior >> anterior); F, G. Transthoracic apical four chamber view showing the mitral bioprosthesis without (F) and with color Doppler without residual mitral regurgitation (G); LV : left ventricle; LA : left atrium; AL : anterior leaflet; PL : posterior leaflet.
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Transthoracic echocardiography showed massive left atrial (LA) dilation with LA volume of 1134 mL and index LA volume > 10 times the cutoff value for severe LA dilation (493.9 mL/m2, severe > 48 mL/m2; Fig. 1A). Mitral regurgitation (MR) was severe (PISA radius 2.4 cm, regurgitant volume 255 mL, effective regurgitant orifice area 23 mm2; Fig. 1B). Transoesophageal echocardiography showed leakage on the whole coaptation line, a 5 mm-coaptation gap, massive annular dilation (7 cm), posterior leaflet length of 13 mm (Fig. 1C-E, Suppl. Post-operative LVEF was 30% and mean gradient 6.5 mmHg (Fig. 1F, G, Suppl.