3D echocardiogram MV apparatus changes

Geometric deformations in mitral apparatus quantifiable by 3DE. A morphological understanding of the derangements in the mitral valve apparatus could guide the reconstructive approach.
(A) Volumetric reconstruction depicting a normal saddle-shaped mitral annulus (yellow with green stripes; arrows) with preserved annular-papillary muscle (red; dashed arrows) anatomic relationship.
(B) Mitral valve with prolapsing leaflets (P1, P2) demonstrating increased planarity and annular dimensions.
(C) Mitral valve in ischemic cardiomyopathy depicting a funnel-shaped deformity (loss of saddle-shape), displacement of the coaptation zone, and increase in annulus-to-papillary muscle tethering length.
(D) Mitral valve in a nonischemic cardiomyopathy patient. Volumetric reconstruction demonstrates similarly the funnel-shaped deformity with severe bilateral displacement of the papillary muscles mediolaterally and posteriorly quantified as tenting volume and angle.