Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Laboratory for Percutaneous Surgery, Queen's University, Kingston, Ontario, Canada.
Ann Thorac Surg. 2022 Feb;113(2):654-662. doi: 10.1016/j.athoracsur.2020.12.013. Epub 2020 Dec 24.
Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the 3-dimensional (3D) structure of the atrioventricular canal annulus before repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has been neither quantified nor rigorously compared with a normal mitral valve annulus.
The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared with the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis).
The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height-to-valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases (P < .001).
The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height-to-valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.
完全性房室管（CAVC）的修复常伴有房室瓣反流，尤其是左房室瓣。在修复前了解房室管瓣环的三维（3D）结构，可能有助于优化修复。然而，CAVC 瓣环的 3D 形状和运动既未被量化，也未与正常二尖瓣瓣环进行严格比较。
使用经胸 3D 超声心动图和定制代码，对 43 例 CAVC 患者的完整瓣环在 4 个心动周期进行建模。使用 3D 度量和统计形状分析（Procrustes 分析）比较瓣环结构与 20 例正常儿科二尖瓣瓣环。
未经修复的 CAVC 瓣环在整个心动周期中形状变化显著。Procrustes 分析直观地表明，正常二尖瓣瓣环的平均归一化 CAVC 环形形状更趋于平面。定量分析显示，左 CAVC 未修复房室瓣的瓣环高度与瓣口宽度比值在所有收缩期均显著低于正常二尖瓣（P<.001）。
CAVC 瓣环的左半部分比正常二尖瓣瓣环更趋于平面，瓣环高度与瓣口宽度比值与功能失调的二尖瓣相似。鉴于瓣环形状对二尖瓣功能的重要性，进一步探索 CAVC 中 3D 结构与瓣功能的关系是有必要的。
