Clinical significance of mitral leaflet flail

Abstract

Background: There has been scant academic consideration paid to investigations of mitral leaflet flail in terms of clinical profile, surgical strategy, and surgical outcome.
Methods: One hundred consecutive patients with mitral leaflet flail referred for surgical treatment in the past 4^2/3 years were included in this study.
Results: The most common reasons leading to mitral leaflet flail were chord rupture (38%), myxomatous degeneration (23%), and combined chord rupture and myxomatous degeneration (12%). Mitral leaflet flail was predominantly characterized by independent P₂ flail, followed by P_2,3 flail and independent A₂ flail. Chord rupture occurred in 54 patients, and the most commonly involved segments were P₂, P_2,3, and P₃. The most common risk factors for mitral valve replacement were papillary muscle rupture, extensive myxomatous degeneration, extensive chord rupture, and severely dilated mitral valve annulus. Multivariate regression analyses demonstrated that the development of mitral leaflet flail was significantly associated with the pertinent variables tested, especially correlated with insertion of the prosthetic ring, number of artificial chord, and presence of carotid stenosis.
Conclusions: Mitral leaflet flail may affect patients of any age, but is more prevalent among males and younger patients. Mitral chord rupture was the leading cause for mitral leaflet flail. Myxomatous degeneration, infective endocarditis, mitral annulus calcification, and papillary muscle rupture were the next most common causes. An increased incidence of mitral leaflet flail was closely related to the chords of the posterior leaflet and the middle scallop. Due to the progressive disappointing prognosis of mitral leaflet flail, surgery should be performed at an early stage.