| A preliminary study on the relationship between mitral chordae tendineae length and left ventricular size in adults of Han nationality and the establishment of normal reference range of chordae tendineae lengthObjective:To explore the relationship between mitral chordae tendineae length and left ventricular size in Han adults,and to establish the normal reference range of mitral primary chordae tendineae length in Han adult males and females,so as to provide guidance for determining the length of mitral chordae tendineae in mitral valve repair.Methods : The echocardiographic data of 388 Han adults who underwent cardiac ultrasound examination in the Department of Cardiovascular surgery of the first affiliated Hospital of Anhui Medical University from January 2019 to August 2022 were collected.According to the left ventricular end-diastolic anteroposterior diameter(LVEDD)≥55mm in males,LVEDD≥50mm in females,and mitral regurgitation in patients with mitral valve prolapse,they were divided into three groups:normal group(n=185),pathological group(n=150)and cardiac enlargement group(n=53).The pathological group was patients with mitral valve prolapse and cardiac enlargement.The lengths of the primary chords of the three groups were compared to see if there was a statistical difference(P<0.05),and then Bonferroni multiple comparison analysis was performed,and finally the lengths of the primary chords in the A2 and P2 areas of the male and female patients were compared separately and formulated the 95% normal value reference range of the length of the primary chordae in the A2 and P2 areas of male and female.Results:1.A total of 388 adult Han patients were included in this study,including 216 males(55.67%)and 172 females(44.33%).There was no significant difference in the chordae tendineae of A2 area among normal group,pathological group and cardiac enlargement group[(18.87 ±0.74)mm vs.(19.06 ±0.69)mm vs,(18.92 ±0.89)mm,P=0.060].The comparison of chordae tendineae in P2 area was [(16.20 ±0.98)mm vs.(16.46 ±0.84)mm vs.(16.17 ±1.03,P = 0.021].Multiple Bonferroni comparison showed that there was significant difference in the length of chordae tendineae between normal group and pathological group(P=0.031),but there was no significant difference between the other two groups(P>0.05).2.The length of A2 chordae tendineae in male patients were compared among normal group(n=104),pathological group(n=98)and cardiac enlargement group(n=14).The length of A2 chordae tendineae was compared [(19.00 ±0.78)mm vs.(19.14 ±0.67)mm vs.(19.41 ±1.07)mm,P=0.097],P2 chordae tendineae length was compared[(16.47 ±0.98)mm vs.(16.62 ±0.67)mm vs.(16.84 ±0.74)mm,P=0.211].There was no significant difference(P>0.05).The length of A2 chordae tendineae in female patients were compared among normal group(n=81),pathological group(n=52)and cardiac enlargement group(n=39).The length of A2 chordae tendineae was compared[(18.70 ±0.67)mm vs.(18.91 ±0.72)mm vs.(18.74 ±0.75)mm,P=0.237],P2 chordae tendineae length was compared [(15.84 ±0.86)mm vs.(16.16 ±1.03)mm vs(15.93±1.02)mm,P=0.177].There was no significant difference(P>0.05).Bonferroni multiple comparison,there was no significant difference in A2 and P2 chordae tendineae length in male and female groups(P>0.05).3.The length of A2 and P2 chordae tendineae approximately obeys normal distribution.The normal distribution method is used to obtain 95% of the reference value range of A2 and P2 chordae tendineae length in adult males and females,respectively.The length of chordae tendineae in the A2 region of Han adult males was(19.10 ± 0.75)mm,and the reference range was(17.63-20.57)mm.The length of chordae tendineae in the P2 region was(16.57 ± 0.84)mm,and the reference range was(14.92~18.22)mm.The length of chordae tendineae in the A2 region of Han adult women was(18.78 ± 0.71)mm,and the reference range was(17.39~20.17)mm.The length of chordae tendineae in the P2 region was(15.96 ± 0.95)mm,and the reference range was(14.10~17.82)mm.Conclusion: The preliminary results showed that the compensatory enlargement of the left ventricle caused by mitral regurgitation after mitral valve prolapse in adult Han patients did not cause the increase of the length of the primary chordae tendineae in the A2 and P2 regions of the mitral valve.The normal reference range of the length of the chordae tendineae in the male A2 region is(17.63 ~ 20.57)mm,P2(14.92 ~ 18.22)mm;the normal reference range of chordae tendineae length in female A2 area was(17.39~20.17)mm,P2(14.10~17.82)mm.Improvement of artificial chordae implantation technique :An implant technique with adjustable artificial chordae length and its early clinical resultsObjective : To explore the feasibility of a length adjustable artificial chordae implantation technique and its early clinical results.Methods:Twenty-four patients with severe mitral regurgitation were treated in the first affiliated Hospital of Anhui Medical University from January 2021 to August 2022.All patients underwent mitral valvuloplasty using the length adjustable artificial chordae tendineae implantation technique designed by our center.Early clinical results were recorded during follow-up.Results : Mitral valvuloplasty was successfully performed in 24 patients with the adjustable length artificial chordae tendineae technique,with an average of(3.08±1.18)artificial chordae tendineae implanted,the aortic clamping time was(74.75±12.46)min,and the cardiopulmonary bypass time was(93.29±15.00)min.There were no perioperative deaths,1 case of postoperative pulmonary infection,2 cases of new atrial fibrillation.All patients were discharged smoothly after symptomatic treatment.During the follow-up period,there were no deaths,the NYHA cardiac function classification,left ventricular end-diastolic diameter(LVEDD)and cardiac output(CO)of 24 patients at 1 week,1 month and 6 months after operation were significantly improved compared with those before operation,and the difference was statistically significant(P<0.05).The left ventricular ejection fraction(LVEF)decreased at 1 week and 1month after operation compared with that before operation(P<0.05),and increased at 6months after operation compared with that before operation(P<0.05).Echocardiographic results showed that mitral regurgitation was significantly improved after operation and during follow-up.Conclusion:The length-adjustable artificial chordae tendineae implantation technique is safe and effective in the treatment of mitral insufficiency,with simple operation,good repeatability,and good early clinical effect. |
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