Morphological Changes Of Mitral Valve Geometry Caused By Repair Procedure

[Objectives]To assess the morphological difference between the normal mitral apparatus and the pathological ones before and after the mitral valve repair procedure with the use of real-time three-dimension transesophageal echocardiography by collecting the parameters of mitral annulus and leaflets.By this method,we can research the effect on mitral valve geometry caused by mitral valve repair procedure.In addition,we compare the different background and morphological result of leaflet resection technology and artificial chordae replantation in treatment of posterior prolapse.[Methods]36 patients undergoing mitral valve repair with more than moderate mitral valve regurgitation was collected as operation group retrospectively,the parameters of mitral annulus and leaflets were collected before and after mitral valve repair.The normal control group including 56 patients with normal mitral valve apparatus were performed three-dimension transthoracic echocardiography to achieve the same parameters.Compare the annulus and leaflets parameters between the operation and normal control groups before and after the mitral valve repair procedure,we can estimate the morphological effect of the procedure and whether the pathological mitral apparatus can be restored to the normal anatomy.Patients with posterior leaflet prolapse were divides into two subgroups by the different technology(resection technology or artificial chordae replantation technology)used in the repair procedure.Parameters were compared to analysis the background and morphological effect of the two.[Results]We successfully collect the parameters of mitral annulus and leaflets,including the parameters about annulus such as the anterior to posterior diameter of the mitral annulus?the anterolateral to posteromedial diameter of the mitral annulus?ellipse index of the two-dimensional view?non-planar leaflet angle?the minimum circumference of the three-dimensional view of the annulus?the minimum area of the two-dimensional view of the annulus?the minimum area of the three-dimensional view of the annulus,and the parameters about leaflets such as the leaflet tenting volume?the leaflet tenting height?the exposed area of the anterior leaflet?the exposed area of the posterior leaflet?inter-commissural diameter?anterior coaptation length of the two-dimensional view?posterior coaptation length of the two-dimensional view?anterior coaptation length of the three-dimensional view?posterior coaptation length of the three-dimensional view and the aorto-mitral angle.Analysising the parameters,we discover that ellipse index of the two-dimensional view?non-planar leaflet angle were decreased while the other parameters were increased significantly in patients with mitral valve prolapse compared with controls before mitral valve repair.But after mitral valve repair,we find that operated patients displayed smaller the anterior to posterior diameter of the mitral annulus?the anterolateral to posteromedial coaptation diameter?ellipse index of the two-dimensional view?the minimum circumference of the three-dimensional view of the annulus?the minimum area of the two-dimensional view of the annulus?the exposed area of the anterior leaflet?inter-commissural diameter but larger non-planar leaflet angle than controls after repair,and the rest parameters were similar.All the parameters in subgroups of posterior leaflet prolapse show no significant difference whenever before and after mitral valve repair procedure.[Conclusion]The repair procedure can restore the function of the mitral valve effectively with the use of proper technology.We successfully collect the parameters of mitral annulus and leaflets by three-dimension transthoracic echocardiography.The pathological mitral apparatus are expanded obviously compared with the normal ones.In view of the morphology,the geometry of the mitral valve annulus is still different,smaller in some extent,from the normal apparently after the mitral valve repair,but the almost normal morphology of the leaflets can be regained.It seems to have similar curative effect morphologically for patients with posterior leaflet prolapse to have resection technology or artificial chordae replantation technology.