{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T17:43:17Z","timestamp":1758476597948,"version":"3.40.5"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:00:00Z","timestamp":1618272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","award":["35526255"],"award-info":[{"award-number":["35526255"]}],"id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The World Heart Federation (WHF) screening criteria do not incorporate a strict, reproducible definition of anterior mitral valve leaflet (AMVL) restriction. Using a novel definition, we have identified two distinct AMVL restriction configurations. The first, called \u201cdistal tip\u201d AMVL restriction is associated with additional morphological features of rheumatic heart disease (RHD), while the second, \u201cgradual bowing\u201d AMVL restriction is not. This \u201carch\u2010like\u201d leaflet configuration involves the base to tip of the medial MV in isolation. We hypothesize that this configuration is a normal variant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>The prevalence and associated leaflet configurations of AMVL restriction were assessed in schoolchildren with an established \u201cvery low\u201d (VLP), \u201chigh\u201d (HP), and \u201cvery high\u201d prevalence (VHP) of RHD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>936 studies were evaluated (HP 577 cases; VLP 359 cases). Sixty\u2010five cases of \u201cgradual bowing\u201d AMVL restriction were identified in the HP cohort (11.3%, 95% CI 8.9\u201314.1) and 35 cases (9.7%, 95% CI 7\u201313.2) in the VLP cohort (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.47). In the second analyses, an enriched cohort of 43 studies with proven definite RHD were evaluated. \u201cDistal tip\u201d AMVL restriction was identified in all 43 VHP cases (100%) and affected the central portion of the AMVL in all cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>\u201cGradual bowing\u201d AMVL restriction appears to be a normal, benign variant of the MV, not associated with RHD risk nor with any other morphological features of RHD. Conversely, \u201cDistal tip\u201d AMVL restriction was present in all cases in the VHP cohort with no cases exhibiting a straight, nonrestricted central portion of the AMVL. This novel finding requires further investigation as a potential RHD rule\u2010out test of the MV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15039","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T11:43:06Z","timestamp":1618314186000},"page":"729-736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The variable spectrum of anterior mitral valve leaflet restriction in rheumatic heart disease screening"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7410-1339","authenticated-orcid":false,"given":"Luke David","family":"Hunter","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Medicine Faculty of Medicine and Health Sciences University of Stellenbosch and Tygerberg Academic Hospital  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton F.","family":"Doubell","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Faculty of Medicine and Health Sciences University of Stellenbosch and Tygerberg Academic Hospital  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso J. K.","family":"Pecoraro","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Faculty of Medicine and Health Sciences University of Stellenbosch and Tygerberg Academic Hospital  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Monaghan","sequence":"additional","affiliation":[{"name":"Kings College Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Echocardiography Laboratory Barts Heart Centre St Bartholomew\u2019s Hospital  London UK"},{"name":"Institute of Cardiovascular Sciences UCL  London UK"},{"name":"William Harvey Research Institute Queen Mary University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl J.","family":"Lombard","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics University of Stellenbosch  Cape Town South Africa"},{"name":"Biostatistics Unit South African Medical Research Council  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip G.","family":"Herbst","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Faculty of Medicine and Health Sciences University of Stellenbosch and Tygerberg Academic Hospital  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy566.P5445"},{"issue":"001452","key":"e_1_2_8_4_1","first-page":"1","article-title":"Interscallop separations of the posterior mitral valve leaflet: a solution to the \u2018borderline RHD\u2019 conundrum?","volume":"7","author":"Hunter LD","year":"2020","journal-title":"Open Hear"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307444"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.003495"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1530\/ERP-18-0010"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(95)00753-8"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia-2019-011233"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12353"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.06.088"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.118.007928"},{"issue":"3","key":"e_1_2_8_14_1","first-page":"134","article-title":"Screening for asymptomatic rheumatic heart disease: Understanding the mechanisms key to the diagnostic criteria","volume":"12","author":"Herbst P","year":"2015","journal-title":"SA Heart"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.15039","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.15039","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.15039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T14:01:17Z","timestamp":1693576877000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.15039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,13]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/echo.15039"],"URL":"https:\/\/doi.org\/10.1111\/echo.15039","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"type":"print","value":"0742-2822"},{"type":"electronic","value":"1540-8175"}],"subject":[],"published":{"date-parts":[[2021,4,13]]},"assertion":[{"value":"2020-10-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}