Three-dimensional transesophageal echocardiography in mitralvalve reconstruction: the role and effectiveness

Authors: Golukhova E.Z., Mashina T.V., Dzhanketova V.S., Shamsiev G.A., Mrikaev D.V., Bockeria L.A.

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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DOI: https://doi.org/10.15275/kreatkard.2016.01.06

For citation: G.A. Shamsiev, D.V. Mrikaev, L.A. Bockeria; Three-dimensional transesophageal echocardiography in mitral valve reconstruction: the role and effectiveness; Kreativnaya Kardiologiya. 2016; 10 (1): 69-83 (in Russian)

Keywords: mitral valve mitral valve insufficiency mitral valve prolapse real-time three-dimensional trans-esophageal echocardiography three-dimentional mitral valve quantification

Полнотекстовая версия:  

 

Abstract

Objective. To estimate the significance of intraoperative transesophageal 3D echocardiography (3D-TEE) to determine the possibility, the expected volume, complexity and efficiency of cardiac surgery in the operating room directly. 

Methods. The study included 55 patients with significant mitral regurgitation (MR) (degenerative, arrhythmo- genic and ischemic origin): 40 (73%) patients underwent reconstructive intervention and 15 (27%) patients – mitral valve (MV) replacement. The mean age was 52.2±13.2 years. 20 people were included in the control group (12 men and 8 women) with no MK pathology, the mean age was 48±13 years. For all patients undergoing MV plasty the MV geometry was assessed intraoperative using 3D-TEE with Mitral Valve Quantification (MVQ) soft- ware before and after the main stage of the surgery. In patients who underwent MV replacement, the geometry of the valve was investigated before implantation and compared with reconstructive procedures group for identifying parameters affecting the choice of tactics operations. 

Results. Patients who underwent MV plastic and prosthetics, had the most significant differences according to the following Echocardiography parameters: multisegment pathology, vertical deformation, the volume and height of the prolapse and tent. According the ROC-analysis of the diagnostic value with respect to the highest forecast of unsuccessful plastic MV and preferences valve prosthesis were: volume of prolapse (p=0.002) the height of tent (p=0.0035) and the chord lenth (p=0.004). Based on the geometric parameters, using MVQ method we identified prognostic factors of inefficiency reconstructive operation on MV: prolapse volume > 3.2 ml, height of tent > 11.5 mm, the length of the anteromedial chord > 28.5 mm, the length of the posteromedial chord > 28.1 mm. After reconstructive surgery geometry of MV approached the regulations.

Conclusions. 3D-TEE and MVQ allow to determine the specific changes of MV anatomy and geometry depend- ing of the MR etiology, to select optimal tactics and complexity of surgical treatment for each patient in the oper- ating room and to evaluate the efficiency of procedure.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery