Transesophageal

Echocardiography
of Mitral Valve
M. Arif Nugroho, MD

Introduction
The mitral valve has triple function :
Regulating blood to LV at low
pressure, while preventing systolic
backflow to LA
Contributes LVOT
formation on
systolic phase
Maintain normal
size, geometry
and function of
Left Ventricle

Components of Mitral Valve

Five Components :
-Annulus
-Leaflets
-Commisures
-Chordae tendinea
-Papillary muscles

Mitral Valve Complex

Normal function of MV depends on complex interaction
of MV components defined as MV complex

Mitral Valve Morphology

Mitral Annulus
- The mitral annulus constitutes the
anatomical junction between the LV and LA,
it serves as insertion site for the leaflet tissue
- Oval and saddle shaped
- its a fibrotic ring that consists of an anterior
part and posterior part
- The annulus is deficient anteriorly at he level
of the aorto - mitral curtain

Continued
The anterior portion of
mitral annulus is attached
to the fibrous trigones
and generally more
developed than posterior
ann.
The aortic mitral curtain
is a fibrous structure that
connects the anterior
mitral annulus intimately
with the aortic valve
annulus (at the level of
the left and NCC)

MITRAL LEAFLETS

Minor Axis
An appropriate measurement of the minor
axis (antero posterior diameter) of the mitral
annulus is performed at end systole during
TTE in the apical long axis view ( 3 chamber
view) or
Its transesophageal equivalent, found at mid
esophageal, with the probe tilted at 120-135o

The Major Axis

(inter commisural diameter)

The major axis is found at a bicommisural two

chamber TEE view
It is when the P1 A2 P3 mitral leaflet
scallops is visualized
Or in a midesophageal bicommisural view at
45-60

View of Minor and Major axises of MV

Anatomic Classification Scheme:

Mitral Valve Segments & Duran Classification

Duran Classification

TEE Assessment of the

Mitral Valve

Mid-esophageal 4C View
A3 and A1

Commisural View
P3-A2-P1

Two Chamber View

P3-A1

Long Axis View

A2

Transgastric Views (Short)

Posteromedial commissure

Anterolateral commissure

Transgastric Views (Long)

Chordae Tendinae

Papillary Muscle

Four Chamber Views vs Two Chamber Views :

Isolating Mitral Valve Leaflet Segments

Two Chamber Views:

Four Chamber Views:

Cardiol Clin. 2000; 18: 731-50.

Mid-esophageal Views
(Transducer @ 0)

Four Chamber View

Two Chamber: Posterior View

Crit Care Clin. 1996; 12: 321-81.

Apical Long Axis View

Cardiol Clin. 2000; 18: 731-50.

Transgastric Long-axis View:

Visualization of the Papillary Muscles

Posteromedial
Papillary Muscle

Anterolateral
Papillary Muscle

Cardiol Clin. 2000; 18: 731-50.