Cardiovascular Sciences, Università Degli Studi di Milano, Milan, Italy.
J Am Soc Echocardiogr. 2012 May;25(5):524-31. doi: 10.1016/j.echo.2012.02.002. Epub 2012 Mar 8.
The aortic valve and the mitral valve (MV) are coupled via fibrous tissue. Simultaneous dynamic analysis of the two valves' annuli has demonstrated that they have synchronous and reciprocal behavior. Accordingly, the aims of this study were to characterize mitral-aortic coupling (MAC) in three-dimensional space before and after MV repair and to identify the untoward effects of annuloplasty rings on MAC compared with normal valvular function.
Real-time three-dimensional transesophageal echocardiography was performed on 28 consecutive patients with degenerative MV disease and severe mitral regurgitation before and after MV repair and in 25 age-matched control subjects. Custom software was used to semiautomatically identify the mitral and aortic annuli throughout the cardiac cycle and to measure parameters describing valvular dynamics.
Patients with mitral regurgitation before MV repair were characterized by altered morphology and function of the MV but preserved MAC because of the maintained ability of the mitral annulus to change size and position. MV repair together with annuloplasty ring implantation forced the mitral annulus to be smaller and less pulsatile, with decreased displacement ability compared with normal mitral annuli. Because of this alteration in MAC, the "unaffected" aortic annulus became less pulsatile and less mobile.
This study shows unwanted and unexpected changes in aortic annular function secondary to mitral valve repair with an annuloplasty ring due to altered MAC mechanisms. These changes may alter the dynamic mechanism of the aortic root that facilitates blood ejection, so MAC should be considered and evaluated from diagnosis to treatment in MV disease.
主动脉瓣和二尖瓣（MV）通过纤维组织连接。对两个瓣环的同步动态分析表明，它们具有同步和相互的行为。因此，本研究的目的是在 MV 修复前后在三维空间中描述 MV 瓣环和主动脉瓣环的耦合（MAC），并确定与正常瓣膜功能相比，瓣环成形环对 MAC 的不良影响。
对 28 例退行性 MV 疾病和严重二尖瓣反流的连续患者在 MV 修复前后和 25 例年龄匹配的对照者进行实时三维经食管超声心动图检查。使用定制软件在整个心动周期中半自动识别 MV 和主动脉瓣环，并测量描述瓣膜动力学的参数。
MV 修复前有二尖瓣反流的患者，其 MV 的形态和功能发生改变，但由于 MV 瓣环保持改变大小和位置的能力，MAC 得以保留。MV 修复伴瓣环成形环植入迫使 MV 瓣环变小且搏动性降低，与正常 MV 瓣环相比，其位移能力降低。由于 MAC 的这种改变，“未受影响”的主动脉瓣环搏动性和活动性降低。
这项研究显示，由于 MAC 机制改变，二尖瓣瓣环成形环修复术会导致主动脉瓣环功能出现意想不到的变化。这些变化可能会改变促进血液射血的主动脉根部的动力机制，因此在 MV 疾病的诊断和治疗中应考虑并评估 MAC。
