Short- and medium-term follow-up outcomes of mitral valvuloplasty guided by real-time three-dimensional transesophageal echocardiography

doi:10.3877/cma.j.issn.1672-6448.2020.05.007

Chinese Journal of Medical Ultrasound (Electronic Edition) ›› 2020, Vol. 17 ›› Issue (05): 427-433. doi: 10.3877/cma.j.issn.1672-6448.2020.05.007

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• Cardiovascular Ultrasound • Previous Articles Next Articles

Short- and medium-term follow-up outcomes of mitral valvuloplasty guided by real-time three-dimensional transesophageal echocardiography

Yuxi Li¹, Xuezeng Xu², Wei Bai³, Bo Wang³, Yawu Chen², Dangxia Zhou⁴^,^†(), Xin Meng³^,^†(), Liwen Liu³

^1. Department of Ultrasound Medicine, First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province; Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi'an 710032, China; Department of Pathology, Medical Department of Xi'an Jiaotong University, Xi′an 710061, China
^2. Department of Cardiovascular Surgery, First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province; Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi'an 710032, China
^3. Department of Ultrasound Medicine, First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xi'jing Hospital); Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province; Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi'an 710032, China
^4. Department of Pathology, Medical Department of Xi'an Jiaotong University, Xi′an 710061, China

Received:2020-03-29 Online:2020-05-01 Published:2020-05-01
Contact: Dangxia Zhou, Xin Meng
About author:
Corresponding author: Meng Xin, Email: 22987143@qq.com;
Zhou Dangxia, Email: zhoudx2010@163.com

Abstract

Abstract:

Objective

To assess the clinical value of mitral valvuloplasty under the guidance of real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and its short-and medium-term effects.

Methods

The clinical data of 147 patients with mitral insufficiency treated by VATS from January 2016 to December 2018 were collected, including 97 males (66%) and 50 females (34%) ranging in age from 10 to 68 (mean, 45.8±14.5) years. RT3D-TEE was performed before operation to help surgeons choose the model of ring and surgical procedure. RT3D-TEE was performed immediately after operation to evaluate the effect of mitral valvuloplasty. Echocardiographic results were recorded during follow-up. The changes in the diameters of the left atrium (LA) and left ventricle (LV), left ventricular ejection fraction (LVEF), and mitral regurgitation or stenosis before and after operation were compared.

Results

There were two cases of surgical failure, in which mitral valve replacement was subsequently performed. The immediate success rate of mitral valvuloplasty was 98.6%. Echocardiography showed that there were 114 cases (78.6%) with no or minimal mitral regurgitation, 19 (13.1%) with mild mitral regurgitation, 10 (6.9%) with mild-to-moderate regurgitation, and 2 (1.4%) with moderate regurgitation. There were no cases with SAM sign (anterior leaflet systolic forward motion), and eight cases had faster mitral flow velocity. Compared with the values before operation, the diameters of LA and LV, end-diastolic volume (EDV) and end-systolic volume (ESV) decreased at 1, 3, and 12 months after operation [LA: (50.9±8.2) mm vs (39.9±7.1) mm, (39.3±5.4) mm, and (39.8±7.9) mm, F=87.032, P<0.05; LV: (56.9±6.8) mm vs (49.0±5.8) mm, (48.2±4.3) mm, and (48.5±6.3) mm, F=71.042, P<0.05; EDV: (135.4±38.6) ml vs (99.1±30.1) ml, (93.1±21.6) ml, and (98.6±37.3) ml, F=52.639, P<0.05; ESV: (58.3±20.9) ml vs (47.7±21.3) ml, (41.8±13.4) ml, and (44.1±25.8) ml, F=18.300, P<0.05]. Compared with preoperative LVEF, the LVEF at 1 and 3 months after operation was slightly lower [(57.5±5.1)% vs (53.1±6.5)% and (55.8±5.6)%, F=14.885, P<0.05). There was no statistical difference between preoperative LVEF and LVEF at 12 months after operation [(57.5±5.1)% vs (56.5±5.9)%, P>0.05]. The mean follow-up time was (23±10) months. All the patients survived during the follow-up, and there was no recurrence of reflux.

Conclusion

RT3D-TEE plays an important role in improving the success rate of operation and reducing the incidence of complications. The success rate is still very high after more than one year of follow-up. The short- and medium-term effects of RT3D-TEE guided thoracoscopic technique in the treatment of mitral regurgitation are satisfactory.

Key words: Real-time three-dimensional transesophageal ultrasound, Mitral valvoplasty, Mitral insufficiency, Mid-term effect evaluation

Yuxi Li, Xuezeng Xu, Wei Bai, Bo Wang, Yawu Chen, Dangxia Zhou, Xin Meng, Liwen Liu. Short- and medium-term follow-up outcomes of mitral valvuloplasty guided by real-time three-dimensional transesophageal echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(05): 427-433.

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References 16

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分组	LA左右径（mm）	LV前后径（mm）	LV长径（mm）	EDV（ml）	ESV（ml）	LVEF（%）	MV-Vmax（cm/s）
术前	50.9±8.2	56.9±6.8	78.9±6.4	135.4±38.6	58.3±20.9	57.5±5.1	120.3±32.5
术后1个月	39.9±7.1^a	49.0±5.8^a	76.9±6.2^a	99.1±30.1^a	47.7±21.3^a	53.1±6.5^a	109.2±26.4^a
术后3个月	39.3±5.4^a	48.2±4.3^a	75.8±6.4^a	93.1±21.6^a	41.8±13.4^ab	55.8±5.6^ab	128.6±31.8^ab
术后12个月	39.8±7.9^a	48.5±6.3^a	76.8±6.4^a	98.6±37.3^a	44.1±25.8^a	56.5±5.9^b	132.1±26.3^ab
F值	87.032	71.042	6.175	52.639	18.300	14.885	13.210
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

分组	LA左右径（mm）	LV前后径（mm）	LV长径（mm）	EDV（ml）	ESV（ml）	LVEF（%）	MV-Vmax（cm/s）
术前	50.9±8.2	56.9±6.8	78.9±6.4	135.4±38.6	58.3±20.9	57.5±5.1	120.3±32.5
术后1个月	39.9±7.1^a	49.0±5.8^a	76.9±6.2^a	99.1±30.1^a	47.7±21.3^a	53.1±6.5^a	109.2±26.4^a
术后3个月	39.3±5.4^a	48.2±4.3^a	75.8±6.4^a	93.1±21.6^a	41.8±13.4^ab	55.8±5.6^ab	128.6±31.8^ab
术后12个月	39.8±7.9^a	48.5±6.3^a	76.8±6.4^a	98.6±37.3^a	44.1±25.8^a	56.5±5.9^b	132.1±26.3^ab
F值	87.032	71.042	6.175	52.639	18.300	14.885	13.210
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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