Basman Craig, Ong Caroline, Kansara Tikal, Kassam Zain, Wutawunashe Caleb, Conroy Jennifer, Kodra Arber, Trost Biana, Mehla Priti, Pirelli Luigi, Scheinerman Jacob, Singh Varinder P, Kliger Chad A
Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
J Cardiovasc Imaging. 2023 Jan;31(1):18-23. doi: 10.4250/jcvi.2022.0043.
Three-dimensional (3D) transesophageal echocardiogram (TEE) is the gold standard for the diagnosis of degenerative mitral regurgitation (dMR) and preoperative planning for transcatheter mitral valve repair (TMVr). TEE is an invasive modality requiring anesthesia and esophageal intubation. The severe acute respiratory syndrome coronavirus 2 pandemic has limited the number of elective invasive procedures. Multi-detector computed tomographic angiography (MDCT) provides high-resolution images and 3D reconstructions to assess complex mitral anatomy. We hypothesized that MDCT would reveal similar information to TEE relevant to TMVr, thus deferring the need for a preoperative TEE in certain situations like during a pandemic.
We retrospectively analyzed data on patients who underwent or were evaluated for TMVr for dMR with preoperative MDCT and TEE between 2017 and 2019. Two TEE and 2 MDCT readers, blinded to patient outcome, analyzed: leaflet pathology (flail, degenerative, mixed), leaflet location, mitral valve area (MVA), flail width/gap, anterior-posterior (AP) and commissural diameters, posterior leaflet length, leaflet thickness, presence of mitral valve cleft and degree of mitral annular calcification (MAC).
A total of 22 (out of 87) patients had preoperative MDCT. MDCT correctly identified the leaflet pathology in 77% (17/22), flail leaflet in 91% (10/11), MAC degree in 91% (10/11) and the dysfunctional leaflet location in 95% (21/22) of patients. There were no differences in the measurements for MVA, flail width, commissural or AP diameter, posterior leaflet length, and leaflet thickness. MDCT overestimated the measurements of flail gap.
For preoperative TMVr planning, MDCT provided similar measurements to TEE in our study.
三维经食管超声心动图（3D-TEE）是诊断退行性二尖瓣反流（dMR）及经导管二尖瓣修复术（TMVr）术前规划的金标准。TEE是一种需要麻醉和食管插管的侵入性检查方法。严重急性呼吸综合征冠状病毒2大流行限制了择期侵入性操作的数量。多排螺旋计算机断层血管造影（MDCT）可提供高分辨率图像和三维重建，以评估复杂的二尖瓣解剖结构。我们假设MDCT能提供与TMVr相关的、与TEE相似的信息，从而在某些情况下（如大流行期间）推迟术前TEE的必要性。
我们回顾性分析了2017年至2019年间接受或接受过dMR的TMVr术前MDCT和TEE检查的患者数据。两名TEE和两名MDCT阅片者在不知道患者预后的情况下进行分析：瓣叶病变（连枷样、退行性、混合型）、瓣叶位置、二尖瓣面积（MVA）、连枷宽度/间隙、前后径（AP）和瓣环直径、后叶长度、瓣叶厚度、二尖瓣裂的存在以及二尖瓣环钙化（MAC）程度。
87例患者中有22例进行了术前MDCT检查。MDCT正确识别瓣叶病变的比例为77%（17/22），连枷瓣叶的比例为91%（10/11），MAC程度的比例为91%（10/11），功能失调瓣叶位置的比例为95%（21/22）。MVA、连枷宽度、瓣环或AP直径、后叶长度和瓣叶厚度的测量结果无差异。MDCT高估了连枷间隙的测量值。
在我们的研究中，对于TMVr术前规划，MDCT提供了与TEE相似的测量结果。
