TY - JOUR
T1 - The Crossed Swords Sign
T2 - Insights into the Dilemma of Repair in Bileaflet Mitral Valve Prolapse
AU - Beeri, Ronen
AU - Streckenbach, Scott C.
AU - Isselbacher, Eric M.
AU - Akins, Cary W.
AU - Vlahakes, Gus J.
AU - Adams, Mark S.
AU - Levine, Robert A.
PY - 2007/6
Y1 - 2007/6
N2 - Background: The need for bileaflet repair in bileaflet mitral valve prolapse (MVP) remains controversial. Will anterior leaflet prolapse resolve with posterior leaflet repair or should both leaflets be addressed? Single-leaflet MVP produces oppositely directed mitral regurgitant jets. Some patients show two crossed jets oppositely directed from the coaptation zone. We hypothesized that these indicate bileaflet lesions requiring complex repair. Methods: Echocardiograms and surgical reports of 52 consecutive patients with MVP undergoing surgery were reviewed. Results: First, all 14 patients with two oppositely directed jets had prolapse of more than one leaflet. Each jet was related to discrete leaflet distortions causing malcoaptation. Six underwent valve replacement. Seven had both leaflets repaired. One had posterior leaflet repair and annuloplasty, with persistent mitral regurgitation requiring valve replacement. Second, 36 of 38 patients with single jets had single-leaflet MVP. One underwent replacement; all others did well with single-leaflet repair. Two patients with bileaflet MVP but only one jet did well with single-leaflet repair or annuloplasty. Conclusion: This crossed swords sign is an important clue to bileaflet mechanism of mitral regurgitation in MVP, associated with complex repair procedures. Thus, it provides a clue in the dilemma of bileaflet versus single-leaflet repair.
AB - Background: The need for bileaflet repair in bileaflet mitral valve prolapse (MVP) remains controversial. Will anterior leaflet prolapse resolve with posterior leaflet repair or should both leaflets be addressed? Single-leaflet MVP produces oppositely directed mitral regurgitant jets. Some patients show two crossed jets oppositely directed from the coaptation zone. We hypothesized that these indicate bileaflet lesions requiring complex repair. Methods: Echocardiograms and surgical reports of 52 consecutive patients with MVP undergoing surgery were reviewed. Results: First, all 14 patients with two oppositely directed jets had prolapse of more than one leaflet. Each jet was related to discrete leaflet distortions causing malcoaptation. Six underwent valve replacement. Seven had both leaflets repaired. One had posterior leaflet repair and annuloplasty, with persistent mitral regurgitation requiring valve replacement. Second, 36 of 38 patients with single jets had single-leaflet MVP. One underwent replacement; all others did well with single-leaflet repair. Two patients with bileaflet MVP but only one jet did well with single-leaflet repair or annuloplasty. Conclusion: This crossed swords sign is an important clue to bileaflet mechanism of mitral regurgitation in MVP, associated with complex repair procedures. Thus, it provides a clue in the dilemma of bileaflet versus single-leaflet repair.
UR - http://www.scopus.com/inward/record.url?scp=34249727803&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2006.11.030
DO - 10.1016/j.echo.2006.11.030
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C2 - 17543739
AN - SCOPUS:34249727803
SN - 0894-7317
VL - 20
SP - 698
EP - 702
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 6
ER -