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Chapter-13 Subvalvular Apparatus in Rheumatic Mitral Stenosis—Methods of Assessment and Therapeutic Implications

BOOK TITLE: Percutaneous Mitral Valvotomy

Author
1. Turgeman Yoav
ISBN
9789352701926
DOI
10.5005/jp/books/14152_14
Edition
2/e
Publishing Year
2018
Pages
9
Author Affiliations
1. Heart Institute Ha, Emek Medical Center Afula, Tel Aviv, Israel, Heart Institute, HaEmek Medical Centre, Afula, Israel
Chapter keywords
Subvalvular apparatus, SVA, rheumatic mitral stenosis, rheumatic heart disease, echocardiography, transesophageal echocardiography, TEE, percutaneous balloon mitral valvuloplasty, PBMV

Abstract

The subvalvular apparatus (SVA) is an integral part of the mitral valve structural complex and includes the left ventricular free wall, two papillary muscles, and chordae tendineae. Subvalvular deformity was noted in 40% of autopsy specimens of patients with rheumatic MS and in two-third of patients undergoing open mitral commissurotomy. Several methods and parameters for assessment of SVA are currently available, yet none are easy to use and can be readily used as a “gold standard”. Current methods are mainly limited due to difficulties in assessment of the different degrees of pathologic involvement of the various valvular structural components. The aims of this review are to describe anatomic and functional aspects of the SVA, and to define SVA involvement in rheumatic MS. The role of noninvasive and invasive methods for evaluating both the integrity and function of SVA in rheumatic disease, as well as clinical implications and pitfalls in assessment of SVA, also covered in this chapter.

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