Calcific Extension Towards the Mitral Valve causes with Non-Rheumatic Mitral Stenosis in Degenerative Aortic Stenosis: Real-Time 3D Transesophageal Echocardiography Study

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The impact of mitral annular calcification on mitral valve (MV) function and the change of flow rate on MV dynamics has not been established in aortic stenosis (AS). 3D transesophageal images of MV were acquired in AS patients and control subjects. Outer and inner border of the mitral annular area (MAA) and mital valve area (MVA) were measured. Stress echocardiography had performed in 10 patients after aortic valve replacement. Inner MAA was significantly smaller in patients with AS compared to control. Maximal anterior and posterior leaflet opening angle and MVA was also significantly smaller. Multivariable analysis revealed that effective MAA and posterior leaflet opening angle were independent predictors for MVA. MVA became larger during stress echocardiography. Its increment was directly correlated to the change in diastolic flow rate.Conclusion: Although calcific extension to MV in AS patients is associated with significant non-rheumatic mitral stenosis, MVA is flow-dependent.