Restricted leaflet motion only in systole, MR caused by LV ischemia/remodeling corresponds to which Carpentier type?

Restricted leaflet motion only in systole, MR caused by LV ischemia/remodeling corresponds to which Carpentier type?

• A. Type IIIa
• B. Type II
• C. Type I
• D. Type IIIb

Answer: (D)

Carpentier’s classification groups MR by how the leaflets move. When leaflet motion is restricted only during systole, this points to a mechanism driven by LV geometry rather than a primary valvular deformity. Ischemic or remodeled LV causes displacement of the papillary muscles and tethering of the leaflets, so they can’t coapt properly in systole, but they can still open relatively normally in diastole. That pattern fits the type where restriction is present in systole only, due to LV remodeling/ischemia. Therefore, the MR is Type IIIb. This differs from: - Type IIIa, where restriction occurs in both systole and diastole, often from rheumatic disease. - Type II, which involves excessive leaflet motion or prolapse. - Type I, where leaflet motion is normal with MR usually from annular dilation or a perforation.

Carpentier’s classification groups MR by how the leaflets move. When leaflet motion is restricted only during systole, this points to a mechanism driven by LV geometry rather than a primary valvular deformity. Ischemic or remodeled LV causes displacement of the papillary muscles and tethering of the leaflets, so they can’t coapt properly in systole, but they can still open relatively normally in diastole. That pattern fits the type where restriction is present in systole only, due to LV remodeling/ischemia. Therefore, the MR is Type IIIb.

This differs from:

• Type IIIa, where restriction occurs in both systole and diastole, often from rheumatic disease.

• Type II, which involves excessive leaflet motion or prolapse.

• Type I, where leaflet motion is normal with MR usually from annular dilation or a perforation.