Evaluation of aortic root changes in hypertrophic obstructive cardiomyopathy patients in perioperative period of modified Morrow procedure with eSie Valves software

doi:10.3877/cma.j.issn.1672-6448.2021.04.003

Abstract

Abstract:

Objective

To evaluate the aortic root parameters of hypertrophic obstructive cardiomyopathy (HOCM) patients in the perioperative period of modified Morrow procedure with eSie Valves software to explore and analyze the change patterns and their causes.

Methods

Three-dimensional images of the aortic root were collected by transesophageal three-dimensional echocardiography (3D-TEE) from 23 HOCM patients in the perioperative period of modified Morrow procedure and 23 healthy volunteers (control group). The 3D model of the aortic root was reconstructed with the eSie Valves analysis system. Related parameters were automatically analyzed and compared.

Results

In the HOCM group, the thickness of the obstruction site and the pressure difference of left ventricular outflow tract were significantly lower than those before surgery (P＜0.001). Postoperative mitral regurgitation was significantly reduced in all patients (P＜0.001). A small amount of central aortic regurgitation occurred in 10 patients (43.5%, 10/23), 4 of whom were new. The preoperative height of the aortic root in the HOCM group was significantly lower than that of normal control group [(20.2±3.5) mm vs (23.5±1.8) mm, P＜0.001]. In the HOCM group, compared with the preoperative data, the postoperative coaptation heights of the aortic valve decreased [(11.7±1.3) mm vs (13.0±1.6) mm, P＜0.05], while the aortic root height increased [(25.0±4.8) mm vs (20.2±3.5) mm, P＜0.05].

Conclusion

The eSie Valves 3D automatic quantitative analysis system can be used to reconstruct the aortic valve root model of HOCM, which reveals parts of the structural abnormalities of the aortic root. Modified Morrow procedure could improve the morphology of the aortic root.

Key words: Trans-esophageal echocardiography, Hypertrophic cardiomyopathy, Modified extended Morrow procedure, Aortic root

Junsong Gong, Fujian Duan, Wenying Kang, Yuhe Jia, Yunhu Song, Hui Li. Evaluation of aortic root changes in hypertrophic obstructive cardiomyopathy patients in perioperative period of modified Morrow procedure with eSie Valves software[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(04): 355-360.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.04.003

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I04/355

Figures/Tables 4

参数	正常对照组（n=23）	HOCM组（n=23）
参数	正常对照组（n=23）	术前	术后
梗阻部位厚度（mm， $x ¯$ ±s）	-	24.6±5.6	13.3±2.5^b
左心房前后径（ mm， $x ¯$ ±s）	37.5±4.7	48.7±2.2^a	40.3±4.4^b
左心室舒张末期内径（mm， $x ¯$ ±s）	45.9±3.6	44.3±4.2	41.7±3.2
左心室射血分数（%， $x ¯$ ±s）	63.5±2.9	76.0±3.5^a	64.3±3.6^b
左心室流出道压差（mmHg， $x ¯$ ±s）	8.4±2.5	78.7±23.2^a	12.7±5.5^b
二尖瓣反流分级 [例（%）]^c
0级	15（65.2）	0	10（43.5）
1级	8（34.8）	3（13.0）	13（56.5）
2级及以上	0	20（87.0）	0
二尖瓣收缩期前向运动[例（%）]	0	16 （69.6）	0^c
主动脉瓣反流分级[例（%）]
0级	23（100.0）	17（73.9）	13（56.5）
1级	0	6（26.1）	10（43.5）

参数	正常对照组（n=23）	HOCM组（n=23）
参数	正常对照组（n=23）	术前	术后
梗阻部位厚度（mm， $x ¯$ ±s）	-	24.6±5.6	13.3±2.5^b
左心房前后径（ mm， $x ¯$ ±s）	37.5±4.7	48.7±2.2^a	40.3±4.4^b
左心室舒张末期内径（mm， $x ¯$ ±s）	45.9±3.6	44.3±4.2	41.7±3.2
左心室射血分数（%， $x ¯$ ±s）	63.5±2.9	76.0±3.5^a	64.3±3.6^b
左心室流出道压差（mmHg， $x ¯$ ±s）	8.4±2.5	78.7±23.2^a	12.7±5.5^b
二尖瓣反流分级 [例（%）]^c
0级	15（65.2）	0	10（43.5）
1级	8（34.8）	3（13.0）	13（56.5）
2级及以上	0	20（87.0）	0
二尖瓣收缩期前向运动[例（%）]	0	16 （69.6）	0^c
主动脉瓣反流分级[例（%）]
0级	23（100.0）	17（73.9）	13（56.5）
1级	0	6（26.1）	10（43.5）

参数	正常对照组（n=23）	HOCM组（n=23）
参数	正常对照组（n=23）	术前	术后
主动脉瓣环内径（mm）	25.0±1.4	25.7±2.7	24.5±2.0
主动脉瓣环面积（mm²）	490.5±52.8	467.3±80.8	461.7±84.1
主动脉瓣缘对合高度（mm）	12.9±0.8	13.0±1.6	11.7±1.3^b
主动脉左冠瓣叶高度（mm）	13.6±0.9	14.2±0.9	14.6±1.7
主动脉无冠瓣叶高度（mm）	14.2±1.0	14.5±0.7	14.1±1.1
主动脉右冠瓣叶高度（mm）	13.7±0.9	12.5±1.6	12.5±2.6
主动脉左冠瓣叶游离缘长度（mm）	28.8±2.0	29.7±2.8	28.9±0.6
主动脉无冠瓣叶游离缘长度（mm）	30.2±2.3	30.2±1.3	28.9±0.5
主动脉右冠瓣叶游离缘长度（mm）	30.3±2.0	30.0±2.4	30.0±1.5
主动脉窦部内径（mm）	31.7±2.2	32.1±1.3	30.7±2.6
主动脉窦部面积（mm²）	762.2±104.6	766.5±78.6	712.9±120.0
主动脉根部高度（mm）	23.5±1.8	20.2±3.5^a	25.0±4.8^b
主动脉窦管交界内径（mm）	29.8±1.5	29.5±1.4	28.3±2.9
主动脉窦管交界面积（mm²）	689.8±70.7	672.6±63.2	622.3±128.2

References 12

1	徐博, 刘金成, 李静, 等. Liwen术式治疗肥厚型心肌病合并完全性右束支传导阻滞的临床研究 [J/OL]. 中华医学超声杂志(电子版), 2020, 17(5): 421-426.
2	刘丽文, 王静. 肥厚型心肌病超声心动图检查规范专家共识 [J/OL]. 中华医学超声杂志(电子版), 2020, 17(5): 394-408.
3	Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J]. Circulation, 2011, 124(6): 2761-2796.
4	常康, 王静, 杨帆, 等. 经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病患者心脏功能的全面评估: 六个月的随访研究 [J/OL]. 中华医学超声杂志(电子版), 2020, 17(5): 409-410.
5	Barlow JB. Perspectives on the mitral valve [M]. Philadelphia: F.A. Davis, 1987: 198-211.
6	Lansac E, Lim KH, Shomura Y, et al. Dynamic balance of the aortomitral junction [J]. J Thorac Cardiovasc Surg, 2002, 123(5): 911-918.
7	Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [J]. Circulation, 2006, 114(5): e84-e231.
8	Mihaila S, Muraru D, Piasentini E, et al. Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography [J]. J Am Soc Echocardiogr, 2014, 27(8): 846-857.
9	Patel P, Dhillon A, Popovic ZB, et al. Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients without severe septal hypertrophy: implications of mitral valve and papillary muscle abnormalities assessed using cardiac magnetic resonance and echocardiography [J]. Circ Cardiovasc Imaging, 2015, 8(7): e003132.
10	Xu H, Yan J, Wang Q, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy in children and adolescents [J]. Pediatric Cardiology, 2016, 37(6): 1-7.
11	Qu SH, Hsiung MC, Leng XP, et al. Three-dimensional transesophageal echocardiographic study of aortic-mitral valve coupling after coronary artery bypass grafting [J]. Echocardiography, 2015, 32(6): 983-992.
12	Tsang W, Veronesi F, Sugeng L, et al. Mitral valve dynamics in severe aortic stenosis before and after aortic valve replacement. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography [J]. 2013, 26(6): 606-614.

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