Tamborini Gloria, Mantegazza Valentina, Penso Marco, Muratori Manuela, Fusini Laura, Ali Sarah Ghulam, Cefalù Claudia, Italiano Gianpiero, Volpato Valentina, Gripari Paola, Caiani Enrico G, Zanobini Marco, Pepi Mauro
Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.
Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy.
J Cardiovasc Dev Dis. 2020 Oct 20;7(4):46. doi: 10.3390/jcdd7040046.
The "ideal" management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 patients who underwent MV repair for MVP with pre-operatory two- and three-dimensional transthoracic echocardiography (2DTTE and 3DTTE) and 6-months (6M) and 3-years (3Y) follow-up 2DTTE. MVP was classified by 3DTTE as simple or complex and surgical procedures as simple or complex. Pre-operative echo parameters were compared to post-operative values at 6M and 3Y. Patients were divided into Group 1 (6M-MR < 2) and Group 2 (6M-MR ≥ 2), and predictors of MR 2 were investigated. MVP was simple in 178/295 pts, and 94% underwent simple procedures, while in only 42/117 (36%) of complex MVP a simple procedure was performed. A significant relation among prolapse anatomy, surgical procedures and residual MR was found. Post-operative MR ≥ 2 was present in 9.8%: complex MVP undergoing complex procedures had twice the percentage of MR ≥ 2 vs. simple MVP and simple procedures. MVP complexity resulted independent predictor of 6M-MR ≥ 2. Favorable cardiac remodeling, initially found in all cases, was maintained only in MR < 2 at 3Y. Pre-operative 3DTTE MVP morphology identifies pts undergoing simple or complex procedures predicting MR recurrence and favorable cardiac remodeling.
对于二尖瓣脱垂（MVP）所致无症状重度二尖瓣反流（MR）的“理想”管理仍存在争议。本研究的目的是确定术前参数，以预测MVP修复术后的残余MR以及早期和长期的良好重塑。我们纳入了295例因MVP接受二尖瓣修复术的患者，术前行二维和三维经胸超声心动图检查（2DTTE和3DTTE），并在术后6个月（6M）和3年（3Y）进行2DTTE随访。通过3DTTE将MVP分为简单型或复杂型，手术方式分为简单型或复杂型。将术前超声心动图参数与术后6M和3Y时的值进行比较。患者分为第1组（6M-MR<2）和第2组（6M-MR≥2），并对MR≥2的预测因素进行研究。295例患者中178例MVP为简单型，94%接受简单手术，而在117例复杂MVP中，只有42例（36%）进行了简单手术。发现脱垂解剖结构、手术方式和残余MR之间存在显著关系。术后MR≥2的患者占9.8%：复杂MVP接受复杂手术时，MR≥2的比例是简单MVP和简单手术患者的两倍。MVP的复杂性是6M-MR≥2的独立预测因素。最初在所有病例中均发现的良好心脏重塑，仅在3Y时MR<2的患者中得以维持。术前3DTTE的MVP形态可识别接受简单或复杂手术的患者，预测MR复发和良好的心脏重塑。
