Clinical Application Study Of Transesophageal Echocardiography In Mitral Valve Repair

[Objective] To evaluate the clinical application value of two-dimensional transesophagealechocardiography (2D-TEE) in mitral valve repair(MVR).[Method] Thirty patients with mitral valve prolapse(MVP) with more than moderate mitralregurgitation referred for MVR at General Hospital of Ningxia Medical University werestudied. All the patients were performed by2D-TEE to evaluate the location of scallop lesionsand ruptured mitral chordae tendineae for mitral valve, and compare with surgical findings.Carpentier’s nomenclature was applied to the mitral valve anatomic localization both2D-TEEand surgery. There were three anterior leaflet scallops defined as A1, A2and A3, and threeposterior leaflet scallops defined as P1, P2and P3.[Results]①There are180location of scallops in thirty patients,43location of scallop lesions werefound by surgical findings. Compaired with surgical findings,2D-TEE was of highsensitivity(87.50%、92.86%), specificity(90.12%、89.76%) and crude agreement(90.00%、90.00%) in the diagnosis of locations of A2and P2, the positive likelihood ratio(8.86、9.07) of2D-TEE diagnosis of locations of A2and P2was the biggest, the negative likelihoodratio(0.14、0.08) was the smallest;②2D-TEE have lower sensitivity(66.67%),specificity(70.06%) and crude agreement(70.00%)in the diagnosis of location of P1than other locations,the positive likelihood ratio(2.23) wasthe smallest,the negative likelihood ratio(0.48) was the biggest.③The sensitivity,specificity,crude agreement,positive likelihood ratio and negative likelihoodratio of2D-TEE diagnosis of ruptured mitral chordae tendineae were90.00%,85.00%,86.67%,6.00,0.67; ④Under the guide of2D-TEE, twenty-eight surgical operations were successful in one timein thirty patients. Mitral regurgitation grade three were found by2D-TEE after operation intwo patients,then mitral valve replacement was taked.[Conclusion]2D-TEE has high value in evaluating the location of lesions and the effects ofMVR． [Objective] To evaluate the clinical application value of real-time three-dimensionaltransesophageal echocardiography (RT-3D-TEE) in mitral valve repair(MVR).[Method] Twenty mitral valve prolapse(MVP) patients with more than moderate mitralregurgitation referred for MVR at General Hospital of Ningxia Medical University werestudied. All the patients were performed by RT-3D-TEE to evaluate the location of scalloplesions and ruptured mitral chordae tendineae for mitral valve,and compare with surgicalfindings. Carpentier’s nomenclature was applied to the mitral valve anatomic localizationboth RT-3D-TEE and surgery. There were three anterior leaflet scallops defined as A1, A2and A3, and three posterior leaflet scallops defined as P1, P2and P3. Mitral valvequantification (MVQ) was performed to quantitatively evaluate lesion size and the effect ofMVR.[Results]①The shape and spatial structure of the scallop lesions and ruptured mitral chordae tendineaeof mitral valve were clearly displayed by RT-3D-TEE, also could be observed through leftatrium view and left ventricular view.②There are120location of scallops in twenty patients,36location of scallop lesions werefound by surgical findings. Compaired with surgical findings, RT-3D-TEE was of highsensitivity(100.00%), higher specificity(95.46%) and crude agreement(95.83%) in thelocation of P2; the positive likelihood ratio of location of P2(22.03)was the biggest; thenegative likelihood ratio(0.00) was the smallest.③RT-3D-TEE have lower sensitivity(66.67%), specificity(83.76%) and crude agreement(83.33%) in the diagnosis of location of P1than other locations, the positive likelihood ratio(4.11) was the smallest,the negative likelihood ratio(0.40) was the biggest.④The sensitivity,specificity,crude agreement,positive likelihood ratio and negative likelihoodratio of RT-3D-TEE diagnosis of ruptured mitral chordae tendineae were100.00%,91.67%,95.00%,12.00,0.00;⑤Eighteen surgical operations were successful in one time in twenty patients. Mitral valvereplacement was taked in two patients;⑥RT-3D-TEE could quantitatively evaluate lesion size and the effect of MVR,the results asfollows:The area and circumference of the mitral annulus in the two-dimensional projectionplane（A2D、C2D）, the circumference of the three-dimensional view of the mitral annulus（C3D）, the anterolateral to posteromedial diameter of the mitral annulus（DalPm）,theanterior to posterior diameter of the mitral annulus（DAP）and annulus height(H) becamesmaller postoperatively than those preoperatively (P＜0.05);The area of the three-dimensional view of the anterior leaflet (A3D Post）, the length ofthe three-dimensional view of the posterior leaflet（L3D Post）,the maximal height of leafletprolapse（HProl）, the volume of leaflet prolapse（VProl）and the arc length of anterolateralto posteromedial coaptation in the two-dimensional projection plane（L2DAlPm）weresignificantly lower postoperatively than those preoperatively(P＜0.05).[Conclusion]RT-3D-TEE could dynamically display the pathological position and quantitativelyevaluate the severity of mitral valve before MVR. It could provide reliable information fordesign of surgical procedure. RT-3D-TEE was a unique new modality for rapid and accurateevaluation of MVR. It has essential value in MVR.