Introduction
Mitral regurgitation accompanies the heart failure with low ejection fraction at the rate of 30-50% (1). The coexistence of functional mitral regurgitation in patients with HfrEF is asscoiated with two fold increase in the mortality rates.(2) Progressive remodelling occurring in heart failure leads to left ventricular dilatation, increase in cavity sphericity, annulus expansion and displacement of papillary muscles result in improper coaptation of the leaflets and functional mitral regurgition. (3)-(4)
Although improvement in the mitral regurgitaion is expected after CRT implantation this is not the case in all of the patients. Several parameters were evaluated for the prediction of improvement of mitral regurgitation after CRT implantation by 2D echocardiography. Tenting hight and interpapillary muscle distance were found to be related to improvement (5).
3D TEE is an integral part of the imaging in mitral valve disesases and has proven to be the most convincing method for understanding the complicated anatomy of the mitral valve and its dynamism.In addition to high quality real time imaging of the mitral valve it allows us to make quantitaive measurements by post process analysis.
Impact of CRT on geometric changes in mital valve apparatus and subvalvular structures and the parameters that would predict the improvement of mitral regurgitation still remain to be elucidated.
The aim of the this study was to evaluate the geometric parameters of mitral valve measured by three dimensional transosephageal echocardiography prior to CRT which would predict the improvement of mitral regurgitation after CRT implantation.