PMC8230166_01
At the top (Panel A), transesophageal echocardiographic views (three chamber view at 124 , four chamber view at 0 , three dimensional "en face" view of mitral valve) showing, in late systole, bileaflet mitral prolapse associated with flail motion of the central scallop of posterior mitral leaflet by chordal rupture and medially and anteriorly directed eccentric severe regurgitation. Mitral leaflets appear large, the chordae elongated and mitral annulus dilated with loss of the coaptation point. In Panel C intraoperative transesophageal echocardiographic views (bi-dimensional view, color view and three-dimensional "en face" view) reporting mitral valve annuloplasty with implantation of the Memo three-dimensional ReChord Ring and the good surgical result suggested by early improvement of mitral regurgitation (1+/4+). In Panel B and D, comparison between preoperative (Panel B) and postoperative (Panel D) speckle-tracking echocardiographic analysis in term of Global Longitudinal Strain, Global Myocardial Work Index and Global Myocardial Work Efficiency of the left ventricular (from left to right). Note the changes of global and segmental findings in bull's eye plots, suggesting a significant left ventricular remodeling after mitral annuloplasty
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F1
Unexpectedly, both transthoracic (transesophageal echocardiography [TTE]) and TTE showed bileaflet mitral prolapse (Barlow's disease) associated with flail motion of the central scallop of posterior mitral leaflet (P2) and first-order chordae tendineae rupture to the posterior leaflet (Type II-Carpentier classification) with eccentric severe regurgitation (4+/4+; regurgitant volume = 69 mL, effective regurgitant orifice area-EROA = 0.42 cm2) [Figure 1, Panel A]. The reduction of the above-mentioned myocardial work (MW) components was particularly pronounced at the level of inferoseptal, inferior and posterior LV segments [Figure 1, Panel B]. Surgical mitral valvuloplasty with implantation of the Memo three-dimensional ReChord Ring was successfully performed without complications [Figure 1, Panel C]. GLS was also reduced (-13.4%) with a regional impairment involving especially septal basal segments, GWI (1318 mmHg%) was lower in comparison with presurgery values, despite its improvement in medium-basal inferoposterior LV segments, whereas GWE was significantly greater (90%) [Figure 1, Panel D].