The Role of Clefts and Cleft-Like Indentations in Mitral Regurgitation Etiology Detected by Three-Dimensional Echocardiography in Patients with Hypertrophic Cardiomyopathy

OBJECTIVE
Mitral regurgitation (MR) is one of the important determinants in hypertrophic cardiomyopathy (HCM) patients. Three-dimensional (3D) echocardiography has revolutionized imaging of mitral valve by allowing real-time direct visualization. The aim of this study is to define the frequency of clefts and cleft-like indentations (CLI) and to determine their contribution to MR in HCM patients.

METHODS
A total of 74 HCM patients with moderate or severe MR who underwent 3D transesophageal echocardiography (TEE) were enrolled. In control group, 200 patients with moderate or severe MR without HCM were selected. Two groups were compared with each other by demographical, echocardiographical features, and cardiac magnetic resonance imaging findings of HCM patients were noted.

RESULTS
Our final patient population was a total of 50 HCM patients after exclusion criteria. HCM patients were younger compared with control group. Clefts or CLIs were present in 14 (28%) HCM group vs. 31 (15.6%) in control group (p=0.041). In the evaluation of MR jet direction according to the presence of cleft or CLI, there was significant association between anteriorly directed jet and the presence of cleft (p=0.003).

CONCLUSION
In this study, the frequency of cleft or CLI is more often in HCM patients compared to control group. Clefts affect direction of the MR jet (anteriorly), while CLIs do not. 3D-TEE can be helpful to make a differential diagnosis in HCM patients with anteriorly directed MR jet. There is no significant efficacy in management of MR by using 3D-TEE to describe CLIs solely.