When mitral valve gets fatigued . . . AML moves differently !
Posted Jan 31 2013 12:00am
Anterior mitral leaflet (AML) is an unique structure in the heart .It is the fastest moving structure inside the heart . It is the first structure visualised by echocardiogram by Elder and Hertz in early 1950s .
While AML is known for vigorous motion , the PML motion is subdued . By tradition AML shows a motion which resembles alphabet M .
But AML is not be taken lightly . It can change it’s motion not only in pathological states but also in health . One such pattern is trifid motion of AML . Following is a Echo Image in a perfectly normal Individual .
Possible mechanisms underlying Trifid motion of AML
The plane of M-mode cut will change the mitral valve motion .(May be this is most common ).M-mode at tip of mitral valve may be trifid ,however a little beyond may record a bifid-M pattern .
Redundant mitral valve
Mid diastolic AML drag
Signs of elevated LVEDP
Finally , it could be a sign of mitral valve fatigue after excrcise . Some of these persons revert back to M pattern after a brief period of Trifid motion following exercise .
Does trifid AML motion result in Tri-phasic doppler flow as well ?
Mitral valve filling is classical E and A .
This usually correspond to M pattern of anatomical AML motion .
Do the anatomy goes hand in hand with physiology ? Will the mid diastolic AML drag result in augmented flow ?