Shojaeifard Maryam, Samiei Niloufar, Firouzi Ata, Sanati Hamid Reza, Mohebbi Bahram, Ghadrdoost Behshid, Erami Sajad, Farrashi Melody
Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Echocardiography. 2019 Oct;36(10):1846-1851. doi: 10.1111/echo.14491. Epub 2019 Oct 1.
Percutaneous mitral commissurotomy (PMC) is currently the treatment of choice for patients with symptomatic mitral stenosis (MS) that have favorable valvular characteristics. We aimed to evaluate the effect of PMC on the longitudinal strain of the right ventricular (RV) free wall in patients with severe MS.
This prospective study recruited patients who underwent PMC. Transesophageal and transthoracic echocardiographic examinations were performed. The mitral valve area (MVA) was measured by three-dimensional evaluation. The RV longitudinal strain was measured via the speckle-tracking method.
A total of 42 patients with a maximum MVA of 1.5 cm underwent PMC in our study. The MVA increased significantly after the procedure (pre-PMC MVA = 0.94 ± 0.20 cm vs post-PMC MVA = 1.45 ± 0.18 cm ; P < .01). Systolic pulmonary artery pressure decreased from 46.05 ± 14.08 mm Hg preprocedurally to 35.86 ± 7.53 mm Hg postprocedurally (P < .01). The mean RV free wall longitudinal strain was -19.00 ± 5.14%, which rose significantly after PMC to -20.97 ± 3.81 (P < .05). There were postprocedural increases, albeit nonsignificant, in the tricuspid annular peak systolic excursion, the peak systolic Doppler velocity of the RV free wall, and fractional area change. The improvement in the RV longitudinal strain was more prominent in the patients with an MVA of less than 1.0 cm .
There was a significant post-PMC rise in the RV free wall longitudinal strain measures in our study population, demonstrating an immediate improvement in the RV systolic function of the patients.
经皮二尖瓣交界切开术（PMC）目前是有症状的二尖瓣狭窄（MS）且瓣膜特征良好患者的首选治疗方法。我们旨在评估PMC对重度MS患者右心室（RV）游离壁纵向应变的影响。
这项前瞻性研究纳入了接受PMC的患者。进行了经食管和经胸超声心动图检查。通过三维评估测量二尖瓣面积（MVA）。通过斑点追踪法测量RV纵向应变。
我们的研究中共有42例最大MVA为1.5 cm的患者接受了PMC。术后MVA显著增加（术前MVA = 0.94±0.20 cm，术后MVA = 1.45±0.18 cm；P <.01）。收缩期肺动脉压从术前的46.05±14.08 mmHg降至术后的35.86±7.53 mmHg（P <.01）。RV游离壁平均纵向应变为-19.00±5.14%，PMC后显著升至-20.97±3.81（P <.05）。三尖瓣环收缩期峰值位移、RV游离壁收缩期峰值多普勒速度和面积变化分数在术后均有增加，尽管不显著。MVA小于1.0 cm的患者RV纵向应变的改善更为明显。
在我们的研究人群中，PMC后RV游离壁纵向应变测量值显著升高，表明患者的RV收缩功能立即得到改善。
