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Does the Mitral annulus dilate with LA enlargement ?

Posted in Cardiology -Mechnisms of disease, Cardiology -unresolved questions, Left atrial enlargement, Mitral annulus -Functional mitral regurgitation, tagged , , , , , on July 10, 2014| Leave a Comment »

We  traditionally believe  LV enlargement  results in dilatation of mitral annulus  from below  and  result in functional MR.
A lesser known  concept is , LA enlargement dilating the  mitral annulus from above and cause MR   !
Can atrial enlargement per se dilate mitral annulus ?

We often find  some degree of MR   associated with chronic  atrial fibrillation.What is the mechanism ?We also know MR begets MR.Is it because of progressive LV or LA enlargement ?

When the literature is searched  we have convincing proof that  LA enlargement can lead to significant  mitral annular dilatation and MR as well .
left atrial enlargement and mitral annuluseffect of la enlargement on mitral annulus
Reference
1.Gertz  Z.M., Raina  A., Saghy  L.; Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 58 2011:1474-1481.
2.Kihara  T., Gillinov  A.M., Takasaki  K.; Mitral regurgitation associated with mitral annular dilation in patients with lone atrial fibrillation: an echocardiographic study. Echocardiography. 26 2009:885-889.
3.Tanimoto  M., Pai  R.G.; Effect of isolated left atrial enlargement on mitral annular size and valve competence. Am J Cardiol. 77 1996:769-774.

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