Department of Anesthesia and Critical Care and Pain Management, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann Thorac Surg. 2009 Dec;88(6):1838-44. doi: 10.1016/j.athoracsur.2009.07.007.
Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair.
We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared.
Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 +/- 14 versus 146 +/- 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings.
Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity.
在二尖瓣（MV）修复过程中应用瓣环成形环已被证明会显著改变二尖瓣环的几何形状。直到最近，由于其非平面取向，对环几何形状变化进行全面的二维超声心动图评估仍然具有挑战性。在本研究中，我们呈现了在冠状动脉旁路移植术期间对二尖瓣修复术前和即刻进行的 MV 环的三维术中经食管超声心动图评估的分析。
我们对 75 例因二尖瓣反流或黏液样二尖瓣病变而行 MV 修复的患者进行了 MV 三维几何分析。在完全环和瓣环成形带修复瓣膜之前和之后，对 MV 进行了几何分析。在手术室中分析获得的三维容积数据。特定的测量包括环直径、瓣叶长度、非平面角度和圆度指数。比较了修复前后的数据。
在获取后 2 至 3 分钟内，69 例（92%）患者可以对 MV 进行完整的超声心动图评估。全环的放置导致原生二尖瓣环的非平面角度增加或鞍形减少（137 ± 14 对 146 ± 14；p = 0.002）。相比之下，部分环放置后非平面角度没有明显变化。
可以在手术室中评估二尖瓣环的非平面性。全瓣环成形环的应用使二尖瓣环变得更加平坦。部分瓣环成形带不会显著改变非平面角度。这两种环都没有恢复原生环形的平面性。
