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Original Articles: Adult Cardiac

Mitral Regurgitation Due to Myxomatous Degeneration Combined With Bicuspid Aortic Valve Disease is Often Due to Prolapse of the Anterior Leaflet of the Mitral Valve

Division of Cardiovascular Surgery, Department of Anesthesia of the Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada

Accepted for publication September 30, 2008.

^_* Address correspondence to Dr David, 200 Elizabeth St, 4N457, Toronto, Ontario, M5G2C4, Canada (Email: tirone.david{at}uhn.on.ca).

Background: This study examines the clinical, echocardiographic, surgical, and pathologic features of patients who had heart valve operations for combined congenital bicuspid aortic valve and mitral regurgitation due to degenerative disease of the mitral valve.

Methods: A retrospective review of 1595 patients who had procedures for mitral regurgitation due to degenerative disease of the mitral valve and 1820 patients who had procedures for congenital bicuspid aortic valve disclosed 29 patients who had combined diseases.

Results: The most common morphology of the bicuspid aortic valve was type 1 (fused right and left aortic cusps). Mitral regurgitation in 21 of 29 patients was caused by prolapse of the anterior leaflet, which was exceptionally large (mean height, 36.5 ± 6.6 mm). Patients with prolapsed anterior leaflet of the mitral valve were younger (48 ± 13 years vs 58 ± 16 years, p = 0.01) and 95% were men. The bicuspid aortic valve was incompetent in 19 of 21, and the aortic annulus exceeded 30 mm in 20 of 21 patients.

Conclusions: Patients with combined mitral regurgitation due to myxomatous degeneration and bicuspid aortic valve disease who require operations often have a large, prolapsing anterior leaflet of the mitral valve and dilated aortic annulus with aortic insufficiency due to cusp prolapse.

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