Background

Ventricular-annular decoupling is thought to exist in all degenerative myxomatous mitral valve (MV) diseases. However, the annular physiology of degenerative MV disease may differ when severe mitral regurgitation (MR) presents at different stages. The aim of this study was to assess differences in mitral annular physiology and surgical effects between early- and late-stage severe MR.

Methods

Three-dimensional (3D) transesophageal echocardiography was performed before and after MV surgery in 74 patients with degenerative MV disease, including 57 with early-stage severe MR (without left ventricular remodeling) and 17 with late-stage MR (with left ventricular remodeling). A control group comprised 46 patients without MV disease. Novel 3D MV software was used to evaluate mitral annular dynamics. The degree of annular saddle shape was calculated as the ratio of annular height (AH) to lateromedial diameter (LM). Ventricular-annular decoupling was defined as insufficient systolic AH/LM compared with the control group.

Results

Prebypass 3D measurements demonstrated that systolic AH/LM in the early-stage group (0.19 ± 0.04) was similar to that in the control group (0.21 ± 0.05; P = .101), while systolic AH/LM in the late-stage group (0.17 ± 0.04) was lower than that in the control group (P = .011). Postbypass comparison showed saddle shape accentuation in the early-stage group (0.20 ± 0.04), similar to that in the control group (P = .3127); the mitral annulus remained flat in the late-stage group (0.17 ± 0.03; P = .004).

Conclusions

Ventricular-annular decoupling, present in the late-stage group, was absent in the early-stage group. MV repair surgery did not disrupt mitral annular saddle shape in the early-stage group; however, it failed to correct annular dysfunction in the late-stage group. Sequential 3D transesophageal echocardiographic analysis provides comprehensive mitral annular evaluation beyond conventional two-dimensional parameters for determining stages of severe MR.

中文翻译：

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退行性二尖瓣关闭不全患者手术修复中二尖瓣环生理的三维超声心动图评估：早期和晚期重度二尖瓣关闭不全的比较

背景

心室-瓣环去耦被认为存在于所有退化性粘液瘤性二尖瓣（MV）疾病中。但是，当在不同阶段出现严重的二尖瓣关闭不全（MR）时，变性MV疾病的环形生理可能会有所不同。这项研究的目的是评估早期和晚期重型MR之间的二尖瓣环生理和手术效果的差异。

方法

MV手术前后对74例变性MV病患者进行了三维（3D）经食道超声心动图检查，包括57例早期严重MR（无左室重塑）和17例晚期MR（左室重塑） 。对照组包括46例无MV疾病的患者。新型3D MV软件用于评估二尖瓣环动力学。环形鞍形的程度被计算为环形高度（AH）与径向内膜直径（LM）之比。与对照组相比，心室-瓣环去耦被定义为收缩期AH / LM不足。

结果

旁路3D测量显示，早期组的收缩期AH / LM（0.19±0.04）与对照组（0.21±0.05; P  = .101）相似，而晚期组的收缩期AH / LM （0.17±0.04）低于对照组（P  = .011）。旁路后比较显示早期组的马鞍形加重（0.20±0.04），与对照组相似（P  = .3127）；二尖瓣环在晚期组中保持平坦（0.17±0.03；P  = .004）。

结论

晚期组中不存在心室-瓣环去耦，早期组中不存在。在早期阶段，MV修复手术并未破坏二尖瓣环的鞍形。但是，它未能纠正晚期组的环形功能障碍。顺序3D经食道超声心动图分析可提供全面的二尖瓣环评估，超越常规的二维参数来确定严重MR的阶段。