Quantitative Analysis Of Mitral Valve Tridimensional Anatomy And Function By Real-time Three-dimensional Transesophageal Echocardiography

ObjectiveTo investigate the value of quantitative evaluating mitral valve tridimensional anatomy and function by real-time three-dimensional transesophageal echocardiography.MethodsPhilips iE33 equipped X7-2t transesophageal pure wavelet matrix real-time three-dimensional plane probe was used to detect eighty-seven patients[46 female,41 male,mean age(51.64±14.07) years]who were examined by RT-3D-TEE from 2008 June to 2009 February.RT-3D-TEE real-time diplayed three- dimensional images and saved images as disks when finishing examine.All patients were divided into four groups,Rheumatic valvular heart disease 22 cases,Atrial septal defect 20 cases,Mitral valve prolapse 4 cases,Paroxysmal atrial fibrillation,Supraventricular tachycardia and others 41 cases as control group.Three groups in front were compared with control group.MVQ software was used to quantitatively analyze mitral valve:area of mitral valve annulus in project plane(A2D),area of anterior leaflets(A3D Ant),area of posterior leaflets(A3D Post),perimeter of mitral valve annulus(C3D),anterolateral to posteromedial diameter of annulus(DAIPm),anterior to posterior diameter of annulus (DAP),annulus height(H),maximal prolapsing height(Hprol),maximal tenting height (HTent),length of coaptation in projection plane(L2DAlPm),length of anterior leaflets (L3D Ant),length of posterior leaflets(L3D Post),length of the anterolateral chordae tendineae(LChord Al),length of the posteromedial chordae tendineae(LChord Pm),volume of leaflet prolapse(Vprol),volume of leaflet tent(VTent),aortic orifice to mitral plane angle(θ),angle of anterior leaflets(θAnt),non-planar angle of leaflets(θNPA),angle of posterior leaflets(θPost).ResultsComparing with control group,A2D,A3D Ant,A3D Post,C3D,DAIPm,DAP,L2DAIPm,L3D Post,θin the group of rheumatic valvular heart disease disyinctly increased.The differences had statistical significance(P＜0.05).In the group of atrial septal defect all these parameters as A2D,A3D Ant,DAIPm,HTent,L2DAIPm,VTent,θAnt,θPost descreased obviously,but asθ,θNPA were increased.The differences had statistical significance(P＜0.05).All these parameters in the group of mitral valve prolapse as A2D,A3D Post,DAIPm,Hprol,VProl,θincreased clearly.The differences had statistical significance(P＜0.05).Conclusions.RT-3D-TEE can be used to display three-dimensional structure of mitral valve on-line and quantitatively analyze mitral vavle tridimensional anatomy and function.It could improve the diagnostic accuracy of mitral valve disease.In short,RT-3D-TEE has wide prospect in clinic application for diagnosis and treatment of mitral valve diseases.2.RT-3D-TEE shows that mitral valve annulus is saddle-backed.The mitral valve annulus tridimensional anatomy changes in the cardiac cycle.These parameters measured in the study provides quantitative basis for mitral valve annulus configuration.It would be propitious to reasonablely design the artificial mitral valve annulus.3.RT-3D-TEE can definite mitral valve prolapsed region and area involved,It also can evaluate tendon rupture and measure these perimeters such as area of annulus in projection plane,perimeter of annulus,maximal prolapse height,volume of the leaflets prolapse.Thus,it provide accurate quantitative diagnosis with standard and postoperative evaluation for patients of mitral valve prolapse.4.Compared with control group,in the group of rheumatic valvular heart disease the mitral valve annulus is dilated and area of annulus in projection plane is larger. Quantitative analysis of mitral vavle in the group of rheumatic valvular heart disease by RT-3D-TEE will provide the the quantitative basis,which would be propitious to formulate preoperative selection criteria and evaluate postoperative effect for the balloon dilate- tion of mitral valve.5.Compared with control group,the first study to quantitative analysis of mitral valve shows that the mitral valve annulus is relatively narrow and area of anterior leaflet is smaller.The mitral valve annulus and mitral valve leaflets appeared deformation.It points out that the flow of atrial septal defect can affect three-dimensional structure of the mitral valve,which may be interrelated to the size of atrial septal defect.