Echocardiography Quantitative Analysis Of The Effect Of Mitral Valve And Left Ventricular Structure On The Effect Of Mitral Valvuloplasty

Part 1 RT-3D-TEE on the structure and function of mitral valve before and after mitral valvuloplastyObjective: To compare the valve structure and function parameters before and after mitral regurgitation in patients with mitral regurgitation.Explore the correlation between valve structure and function parameters with mitral regurgitation(MR).Methods: A total of 43 patients with mitral regurgitation diagnosed by echocardiography in the Department of Cardiothoracic Surgery of our hospital from October 2019 to December 2020 were included.Among them,30 patients underwent mitral valvuloplasty and 13 patients underwent mitral valve replacement.Acquire real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)images before and immediately after valvuloplasty,and use offline analysis software to quantitatively measure mitral valve parameters,including(1)Annulus parameters: annulus area(AA),anterior-posterior Diameter(DAP),posteromedial to anterolateral diameter(DPm Al),annulus height(AH),sphericity index(SI),non-planar angle(NA),aortic-mitral annulus angle(AMA);(2)Valve parameters: anterior leaflet area(ALA),posterior leaflet area(PLA),total valve area/annular area(TLA/AA),tenting height(TH),tenting area(TA),tenting volume(TV);(3)Annulus motion function parameters: mitral valve annulus excursion(MAE),mitral annulus excursion max velocity(MAVm),annulus area fraction(AA%).(4)Transthoracic echocardiography(TTE)was performed before and early postoperatively(within 7 days after operation),and the left atrial diameter(LA),left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),volume of mitral valve regurgitation were measured and recorded.The paired t test was used to compare the above-mentioned parameters before and after the valvuloplasty,and the Pearson correlation was used to analyze the correlation between the parameters of the mitral valve and the volume of Mitral valve regurgitation.Results:(1)Annulus and motion parameters: AA,DAP,DPm Al,SI,AH decreased compared with preoperatively(P<0.05),NPA,MAVm increased compared with preoperative(P<0.05).No statistical difference in AMA,MAE,AA%(P>0.05);(2)valve parameters: ALA,PLA,TA,TV were reduced compared with preoperatively(P<0.05),TLA/AA was increased compared with preoperatively(P<0.05),No statistical difference in TH(P>0.05);(3)LA,LVEF,LVEDV,and volume of mtrial valve regurgitation were lower than those before operation(P<0.05).The volume of mitral valve regurgitation of 30 patients before operation was positively correlated with AA,DAP,PLA(r =0.530,0.496,0.551,P<0.05);it was negatively correlated with TLA/AA(r =-0.418,P<0.05);there was no significant correlation with DPm Al,SI,NPA,AH,ALA(P>0.05).Postoperative volume of mitral valve regurgitation was positively correlated with DAP(r = 0.484,P < 0.05);it was negatively correlated with TLA/AA(r =-0.489,P <0.05);there was no significant correlation between AA,DPm Al,SI,NPA,AH,ALA and PLA(P>0.05).Conclusion: 1.Mitral valvuloplasty promotes the reduction of the valve annulus,the valve leaflets align,and improves MR,but the effect on the annulus movement function is not obvious in a short period of time;2.TLA/AA,DAP,etc.have a good correlation with the volume of mitral valve regurgitation,which can evaluate the severity of MR and the effect of Mitral valvuloplasty;3.RT-3D-TEE combined with mitral valve offline analysis software can quantitatively evaluate the geometric structure and function of the mitral valve,which has important clinical significance.Part 2 Ultrasonographic characteristics of mitral valve and left ventricular structure: predicting factors of systolic anterior motion of the mitral valveObjective: To explore the evaluation value of mitral valve and left ventricular parameters for the anterior mitral valve systolic anterior motion(SAM).Methods: Review forty-six SAM patients diagnosed by echocardiography as SAM group and thirty Normal people were selected as the control group.The differences in the structural parameters of the mitral valve and left ventricle were measured and compared between two groups.Receiver operating characteristic curve was used to obtain the best cut-off value of each parameter predicting SAM.Conduct the correlation analysis between each parameter and pressure gradient of left ventricular outflow tract(LVOT).Results: The mitral annular diameter,length of posterior valve,valve-annular angle,basal-interventricular septum diameter,pressure gradient of LVOT,left ventricular ejection fraction(LVEF)of the SAM group were greater than those of the control group(P<0.05).Aortic-mitral annular angle(AMA),LVOT diameter,coaptation point-Septum distance(C-septum),left ventricular diameter at the coaptation level,ratio of C-septum to left ventricular diameter at the coaptation level were less than the control group(P<0.05);there were no statistically significant difference in the remaining parameters between two groups(P>0.05).The area under the curve of the basal-interventricular septum diameter,C-septum,ratio of C-septum to left ventricular diameter and pressure gradient of LVOT are 0.991,0.960,0.970 and 0.973,respectively.The cut-off values are 11.75 mm,15.95 mm,0.5,27.5 mm Hg.The basal-interventricular septum diameter(r = 0.807),C-septum(r =-0.840),ratio of C-septum to left ventricular diameter(r =-0.816)all have a strong correlation with the pressure gradient of LVOT.Conclusion: 1.The basal-interventricular septum diameter,C-septum,the ratio of C-septum to left ventricular diameter have a high predictive value for SAM.High-risk patients can be identified in time through the best cutoff value.2.The basal-interventricular septum diameter,C-septum,the ratio of C-septum to left ventricular diameter are related to LVOT obstruction caused by SAM,which reflects the clinical symptoms and prognosis of the patient.