| Background:The anatomical or functional abnormalities of mitral and subvalvular devices(annulus,valve leaflets,left ventricular papillary muscle and chordae tendinea)lead to mitral regurgitation(MR).Mitral valve prolapse is one of the most common valvular diseases,which is defined as the disease that mitral leaflets(anterior leaf,posterior leaf or two leaves)part or all off to the left atrium and exceeded the level of mitral valve annulus in ventricular contraction mid-term,later or full systolic stems caused by a variety of reasons.At present,there is no medication to correct or prevent the progress of valvular prolapse,it is necessary to require a early surgical treatment until developed severe MR.Mitral valvuloplasty(MVP)has become one of the most important surgical treatments for patients who had MR with valve conditions permitting.Its biggest advantage is to retain the autologous valve and subvalvular structure,which can preserve the integrity of the left ventricular structure and normal systolic function.Moreover,it won’t require anticoagulant medication for whole life,which can reduce the incidence of complications due to valve replacement,such as thrombosis infective endocarditis,and left ventricular systolic dysfunction.The type,location,affected area of mitral valve and subvalvular devices are the determinant ofthe effect of MVP,accurate and comprehensive assessment of mitral valve structure and function is particularly important for the refinement of individualized treatment.With the three-dimensional ultrasound technology developing to be more mature,real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in the diagnosis and treatment of valvular heart disease has shown a good application prospect.RT-3D-TEE can simulate the generation of three-dimensional model,cutting and rotation without any influence on the position of the patient or the gas in the lungs.And it not only can show the shape,structure and the opening and closing conditions of the mitral valve in different phases of the same cardiac cycle,but more intuitive understanding of the mitral valve,subvalvular devices and adjacent situation.Real-time acquisition and rapid imaging to provide a more accurately physical simulation of information,a clearer view of the mitral valve "surgical zoom of vision",which is contributed to the development of clinical treatment decisions to quantitatively assess their spatial configuration.Object:To quantitatively evaluate the variation of preoperative and postoperative structure and function of mitral valve in mitral valve prolapse for MVP by RT-3D-TEE.Methods:Thirty patients with mitral valve prolapse for MVP were studied,who enrolled from October 2016 to August 2017 in People’s Hospital of Zhengzhou University.RT-3D-TEE was performed immediately before and after hemodynamic stabilization by Philips iE Elite ultrasound scanner,X7-2t transesophageal three-dimensional ultrasound probe,frequency 2.0 ~ 7.0 MHz.Three dimensional circumference(C3D),the minimum area of the three-dimensional view of the annulus(A3Dmin),anterolateral-to-posteromedial diameter(DAIPm),anterior-to-posterior diameter(DAP),height(H),the ratio of annulus height to commissural diameter(H/DAlPm),aorto-mitral angle(θ),the ellipticity of the anterior-to-posterior diameter andanterolateral-to-posteromedial diameter of the annulus(E2D),the three-dimensional exposed area of the leaflet(A3DE),prolapse height(HProl),prolapse volume(VProl),non-planarity angle(θNPA)were evaluated by application QLab9.0 MVQ analysis program.Coaptation area(CoapA),coaptation index(CPI),annulus systolic function were counted.SPSS 17.0 software was applied to investigate all statistical analyses.The data of continuous variables that approximately obey the normal distribution are expressed as Mean±Standard deviation.The paired sample t-test was used to compare the parameters of mitral annulus and leaflets in MVP preoperative and postoperative.Pearson’s correlation Analysis and partial correlation Analysis were applied to analyze the relationship between CPI parameters and valvular systolic function.Bland-Altman plot analysis was used to test the consistency of the mitral valve parameters.Results:1、Compared with the preoperative parameters,the postoperative ones of mitral valve annulus,A3Dmin(479.64±71.36),C3D(80.81±5.75),DAIPm(26.00±2.95),DAP(20.34±1.67),H(2.34±0.85),H/DAlPm(15.92±6.34)were reduced,E2D(128.28±12.42),annulus systolic function(25.72±6.49)were increased,the above parameters were statistically significant differences(P<0.05);The difference of θ was not statistically significant before and after surgery(P>0.05);2、Compared with the preoperative parameters,the postoperative ones of mitral valve leaflets,A3DE(638.88±101.83),HProl(0.07±0.05),VProl(0.00±0.00),θNPA(82.20±17.32)were reduced,CoapA(532.39±159.28),CPI(44.75±7.76)were increased,the above parameters were statistically significant differences(P<0.05).3、Pearson statistical analysis showed that CPI and annulus systolic function were significantly negative correlated with the area of valve regurgitation area both preoperatively and postoperatively(r =-0.79,P <0.01;r =-0.67,P <0.01).Furthermore,Partial correlation statistical analysis showed that CPI and annulus contraction function index was positively correlated(r = 0.63,P <0.01).Conclusion:1、The three-dimensional structural parameters of the mitral valve annulus in patients after MVP are significantly changed,the normal proportion of the annulus,the elliptical shape and the anterior and posterior leaf apical surfaces are recovered,and the systolic function of the annulus are improved;2、The three-dimensional structural parameters of mitral valve leaflets changes significantly after MVP.The prolapse height and volume of leaflet are decreased,the effective area of co-operation is increased,and the degree of leaflet occlusion is improved;3、RT-3D-TEE can quantitatively evaluate the structure and function of mitral valve in patients for MVP both preoperatively and postoperatively.MVP surgery to improve the effectiveness of individualized surgery It provides an effective assessment method to evaluate the effect of refined and individualized MVP surgery in the future. |
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