Pardi Mirian M, Pomerantzeff Pablo M A, Sampaio Roney Orismar, Abduch Maria C, Brandão Carlos M A, Mathias Wilson, Grinberg Max, Tarasoutchi Flavio, Vieira Marcelo L C
Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Echocardiography. 2018 Sep;35(9):1342-1350. doi: 10.1111/echo.14048. Epub 2018 Jun 19.
The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results.
Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated.
There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P = .038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P < .05).
Three-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MR ≥ grade II, what could suggest a potential benefit of early surgical treatment.
确定二尖瓣（MV）修复结果的预测因素对于心脏手术质量的提高至关重要。本研究的目的是评估三维（3D）经食管超声心动图对MV形态学的量化与二尖瓣修复结果之间的关系。
54例接受手术修复的MV脱垂患者根据术后二尖瓣反流（MR）程度分为2组（1组，0-I级MR；2组，≥II级MR）。通过3D MV量化分析与二尖瓣环、瓣叶尺寸和脱垂、瓣叶对合线、乳头肌到瓣叶边缘的距离以及瓣膜角度相关的形态学参数。还评估了心脏重塑和MR定量参数。
3D MV量化与手术结果之间无相关性；多变量分析未显示形态学参数与手术结果之间存在关联。术后MR≥II级的患者，后内侧乳头肌到瓣叶边缘的距离更高（P = 0.038）。有明显残余MR的患者左心房直径、左心室收缩末期直径、左心室舒张末期和收缩末期容积更大（P < 0.05）。
3D MV量化不能预测术后MR分级；然而，后内侧乳头肌到瓣叶边缘的距离可能与修复效果欠佳有关。此外，过度的心脏重塑与术后MR≥II级有关，这可能提示早期手术治疗具有潜在益处。
