| Objectives:Considering the diameters of the aortic annulus(AA)obtained by CT angiography as the standard,the accuracy and repeatability of measuring the diameters of AA in patients with aortic regurgitation(AR)by three-dimensional transesophageal echocardiography(3D-TEE)were evaluated.The main factors affecting the difference between the two imaging methods were also explored.Methods:Patients who were diagnosed with severe AR and required aortic valve surgery were continuously collected.All patients received CT angiography before surgery,and the daimeters of AA were measured by three-dimensional image reconstruction,including the minimum diameter,maximum diameter,area and perimeter of the annulus.At the same time,all the patients were examined by 3D-TEE,and the corresponding diameters of AA were also obtained through three-dimensional analysis software.Univariate and multivariate linear regression methods were used to analyze the main factors affecting the difference between the two imaging methods.Results:A total of 111 patients were finally included.By comparison,the diameters of AA obtained by CT were larger than those obtained by 3D-TEE,but there was no significant difference between the two groups(all p>0.05).The correlation between 3D-TEE and CT method of each diameter of AA was good and the correlation coefficient ranged from 0.73 to 0.89(all p<0.05).The consistency between the two methods was also good and the limits of agreement were small.Moreover,the diameters of AA obtained by 3D-TEE also had good inter-and intra-observer agreement,and the intra-class correlation coefficients were 0.75-0.90(all p<0.05).Through univariate and multivariate linear regression analysis,it was found that when the diameters obtained by CT were used as the actual size of AA,it was the main factor affecting the difference between the two measurement methods,which meant that with the dilation of AA,the difference in the measured values between the two measurement methods incerased.Conclusions:3D-TEE can accurately assess the diameters of AA in patients with AR.It has good correlation and consistency with the CT method,and it also has good repeatability.The main factor affecting the difference between the two measurement methods is the size of AA.The larger the annulus,the greater is the bias in 3D-TEE method.Objectives:To assess characteristics of the aortic annulus(AA)of aortic regurgitation(AR)patients with different etiologies,based on the basis that three-dimensional transesophageal echocardiography(3D-TEE)can accurately assess the size and shape of AA in patients with AR.The patients with AR were classified according to the etiologies followed by the currently commonly used classification method.Methods:The patients who were diagnosed with severe AR and required aortic valve surgery were consecutively collected.All patients were divided into three types according to etiology:the Type Ⅰ was caused by the expansion of the surrounding structures supporting the aortic valve,the Type Ⅱ was caused by the restriction of leaflets movement due to fibrosis or calcification,and the Type Ⅲ was caused by leaflets prolapse affecting their coaptation.At the same time,normal subjects were collected as a control group.All subjects underwent 3D-TEE examination and the diameters of AA were obtained by 3D analysis software to evaluate the size of AA.The aortic annulus eccentricity index and the distance between the three lowest attachment points of the aortic sinuses were obtained to evaluate the geometry of AA.The characteristics of AA between patients with AR and control groups and among different types of AR groups were compared.Results:A total of 145 patients were finally included.The number of three types of AR were 47,45,and 43.There were 50 subjects in the control group.The diameters of AA in patients with AR were larger than those in the control group(all p<0.05),and the increase in the Type Ⅰ was the most obvious,followed by the Type Ⅲ,and the the Type Ⅱ.At the same time,AA changed from a normal ellipse to a circular shape in patients with AR(the aortic annular eccentricity index 0.19±0.07 vs.0.17±0.07,p<0.05),and the change of the Type Ⅰ was also the most obvious.Judging from the distance between the lowest attachment points of the three aortic sinuses and the shape of the aortic annular inscribed triangle formed by the attachment points,the annulus inscribed triangles of the Type Ⅰ and the Type Ⅲ tended to be equilateral triangle.There was no significant difference in the shape of the aortic annular inscribed triangle of the Type Ⅱ compared with the control group.Among the distances between the three attachment points,the left-non-attachment point distance could maintain its relative stability more than other parameters.Conclusions:Compared with the normal subjects,the diameters of AA in patients with AR increase,and the shape of AA tends to be round.The changes of the aortic annular size and shape were the most obvious in the Type Ⅰ,followed by the Type Ⅲ.The aortic annulus structure of the Type Ⅱ is relatively stable.Objectives:To understand the changes of mitral annulus(MA)geometry and dynamic motion evaluated by three-dimensional transesophageal echocardiography(3D-TEE)in patients with aortic regurgitation(AR),and to analyse the correlation between these changes and the degree of functional mitral regurgitation(FMR).Eventually,more mechanisms for the development of FMR were explored.Methods:Patients diagnosed severe AR and required aortic valve surgery were consecutively collected,and those with primary mitral valve diseases were excluded.Normal subjects were collected as the control group in this study.All subjects underwent 3D-TEE examination and 3D image analysis software was used to obtain the main geometrical data of MA,including the area,perimeter,anteroposterior diameter,anterolateral-posteromedial diameter,height,non-planarity angle and the aortic-mitral annulus angle.The percentage changes between the maximum and minimum values of MA area and perimeter in the whole cardiac cycle were calculated to observe the dynamic motion of MA.The differences of the above parameters between AR and the control group were compared.Transthoracic echocardiography was used to evaluate the degree of FMR,and the correlation between the MA parameters and the degree of FMR was also evaluated.Results:A total of 83 patients with AR were collected and 50 normal subjects were included as controls.Through comparison,it was found that MA area,perimeter,anteroposterior diameter,anterolateral-posteromedial diameter,non-planarity angle,and the aortic-mitral annulus angle increased,while the MA height decreased in AR patients(all p<0.05).MA area and perimeter contraction fraction during the whole cardiac cycle were lower than those of the control group(all p<0.05).Through correlation analysis,it was found that the degree of FMR was positively correlated with MA area,perimeter,anteroposterior diameter and anterolateral-posteromedial diameter,with a correlation coefficient of 0.47-0.55(all p<0.05).The degree of FMR was negatively correlated with MA area and perimeter contraction fraction,and the correlation coefficients were-0.46 and-0.43,respectively(both p<0.05).Conclusions:In patients with AR,MA is enlarged,rounded,and flattened,with reduced dynamic motion throughout the whole cardiac cycle.There is a certain correlation between the geometrical and dynamic motion changes of MA and the degree of FMR.Abnormal changes in the mitral annulus may also be one of the important reasons for the formation of FMR.Objectives:To observe the changes of the mitral annulus(MA)and the degree of the accompanying functional mitral regurgitation(FMR)after aortic regurgitation(AR)correction surgery,and then conduct long-term follow-up.The ultimate aim is to provide certain echocardiographic evidence for clinical decision-making of such patients.Methods:Patients with severe AR and no mitral valve-related surgical management during AR correction surgery were consecutively collected.All patients underwent transesophageal three-dimensional echocardiography(3D-TEE)before and after surgery and the mitral annular parameters were obtained.The geometry and dynamic motion of MA before and after the operation were compared.At the same time,all patients underwent transthoracic echocardiography before surgery,before discharge after surgery and during long-term follow-up.The size and function of left heart were compared and the degree of FMR in different periods were also evaluated.Results:A total of 70 patients who met the reqiurements were finally included,and the average follow-up time was 27±7 months.All patients were accompanied by mild or moderate preoperative FMR.After AR correction surgery,the MA area,perimeter,anteroposterior diameter,anterolateral-posteromedial diameter and non-planarity angle decreased immediately.The MA height was greater than that before surgery(all p<0.05).In terms of mitral annular dynamic motion,the MA area and perimeter contraction fraction during the whole cardiac cycle increased compared with those before operation(both p<0.05).Transthoracic echocardiography showed that the left atrium and ventricular sizes of the patients,including left atrial anteroposterior diameter,left ventricular end-diastolic and end-systolic diameters,were smaller than those before surgery,and the left ventricular mass index decreased(all p<0.05).),which suggested a certain degree of left ventricular remodeling.At the same time,FMR was also significantly improved.In long-term follow-up,the patients’left ventricular mass index continued to decrease,and the degree of FMR tended to be stable.Conclusions:The MA geometry and dynamic motion tend to be normal after AR is corrected,and the degree of accompanied FMR also decreases significantly.In the long-term follow-up,it is found that AR correction surgery alone can achieve the relative stability of postoperative cardiac structure and function and the degree of FMR in such patients. |
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