Abstract
Introduction. Preoperative planning for mitral valve repair in patients with Barlow's disease or fibroelastic deficiency is challenging due to the inability to accurately assess the anatomy of the prolapse. A number of authors have shown that there are several potentially important aspects that automated 3D echocardiographic image analysis can contribute to surgery.
Objective: to determine the degree of confirmation of mitral valve pathology by morphological analysis of threedimensional echocardiographic image. To assess the impact of these data on the correction technique and the immediate results of surgical treatment.
Material and methods. The study included 52 patients operated from 2018 to 2019. All had mitral valve prolapse with 3–4+ regurgitation as a result of Barlow's disease or fibroelastic deficiency. The average age of patients was 55.8±10.4 (from 15 to 78) years, women – 13 (24%), men – 39 (75%). Full-volume images with electrocardiographic control were obtained on the iE33 platform (Philips Medical Systems).
Results. The question of the choice and technique of surgical treatment was decided by the operating surgeon on the eve of the operation according to the results of the performed and 3D echocardiographic study. In 23 patients, the chord prosthesis was performed with PTFE threads. In 22 patients with prolapse in the P2 segment, triangular/quadratic resection was performed. The D. McGoon technique was used in five patients. Decalcification and plastic of the fibrous ring with the creation of neochord was used in two cases. All patients were discharged in satisfactory condition.
Conclusion. Detailed morphological analysis of mitral prolapse can be more accurately performed using transesophageal three-dimensional echocardiography, which allows to determine the method and technique of surgical correction of mitral insufficiency before surgery. Valve-saving operations must be performed in a Department owning a variety of techniques of reconstruction of the mitral valve, which increases the chance of preservation of the valve, improves the quality of life of the patient and long-term survival.
References
- Castillo J.G., Adams D.H. Mitral valve repair and replacement. In: Otto C.M., Bonow R.O. Valvular heart disease: A companion to Braunwald's Heart Disease E-Book. Elsevier Health Sciences; 2009: 326–36.
- David T.E. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease. Ann. Cardiothorac. Surg.2015; 4 (5): 417–21. DOI: 10.3978/j.issn.2225-319X.2015.08.07
- Gripari P., Mapelli M., Bellacosa I., Piazzese C., Milo M., Fusini L. et al. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int. J. Cardiovasc. Imaging.2018; 34 (7): 1099–107. DOI: 10.1007/s10554-018-1324-2
- Pouch A.M., Jackson B.M., Lai E., Takebe M., Tian S., Cheung A.T. et al. Modeling the myxomatous mitral valve with three-dimensional echocardiography. Ann. Thorac. Surg. 2016; 102 (3): 703–10. DOI: 10.1016/j.athoracsur.2016.05.087
- Adams D.H., Anyanwu A.C. Seeking a higher standard for degenerative mitral valve repair: begin with etiology. J. Thorac. Cardiovasc. Surg. 2008; 136: 551–6. DOI: 10.1016/j.jtcvs.2007.10.060
- Anyanwu A.C., Adams D.H. Etiologic classification of degenerative mitral valve disease: Barlow's disease and fibroelastic deficiency. Semin. Thorac. Cardiovasc. Surg. 2007; 19: 90–6. DOI: 10.1053/j.semtcvs.2007.04.002
- McGoon D.C. Repair of mitral insufficiency due to ruptured chordae tendineae. J. Thorac. Cardiovasc. Surg. 1960; 39: 357–62.
- Muratov R.M., Sachkov A.S., Babeshko S.S., Fadeev A.A., Soboleva N.N. Early results of the use of polytetrafluoroethylene band for mitral valve annuloplasty. Russian Journal of Thoracic and Cardiovascular Surgery. 2011; 6: 33–7 (in Russ.).
- Carpentier A.F., Chauvaud S., Fabiani J.N. et al. Reconstructive surgery of mitral valve incompetence: ten year appraisal. J. Thorac. Cardiovasc. Surg.1980; 79: 338–48. DOI: 10.1016/S0022-5223(19)37942-5
- Hjortnaes J., Keegan J., Bruneval P., Schwartz E., Schoen F.J., Carpentier A. et al. Comparative histopathological analysis of mitral valves in Barlow disease and fibroelastic deficiency. Semin. Thorac. Cardiovasc. Surg. 2016; 28 (4): 757–67. DOI: 10.1053/j.semtcvs.2016.08.015
- Chandra S., Salgo I.S., Sugeng L., Weinert L., Tsang W., Takeuchi M. et al. Characterization of degenerative mitral valve disease using morphologic analysis of realtime three-dimensional echocardiographic images. Objective insight into complexity and planning of mitral valve repair. Circ. Cardiovasc. Imaging. 2011; 4: 24–32. DOI: 10.1161/CIRCIMAGING.109.924332
- Jouan J., Berrebi A., Chauvaud S., Menasché Ph., Carpentier A., Fabiani J.-N. Mitral valve reconstruction in Barlow disease: Long-term echographic results and implications for surgical management. J. Thorac. Cardiovasc. Surg. 2012; 143 (4, Suppl.): S17–S20. DOI: 10.1016/j.jtcvs.2011.11.016
- Gazoni L.M., Fedoruk L.M., Kern J.A., Dent J.M., Reece T.B., Tribble C.G. et al. A simplified approach to degenerative disease: Triangular resections of the mitral valve. Ann. Thorac. Surg. 2007; 83 (5): 1658–65. DOI: 10.1016/j.athoracsur.2007.01.028
- Tuladhar S.M., Punjabi P.P. Surgical reconstruction of the mitral valve. Heart. 2006; 92 (10): 1373–7. DOI: 10.1136/hrt.2005.067421
- Grigioni F., Avierinos J.-F., Ling L.H., Scott C.G., Bailey K.R., Tajik J. et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J. Am. Coll. Cardiol. 2002; 40: 84–92. DOI: 10.1016/s0735-1097(02)01922-8
- Coutinho G.F., Garcia A.L., Correia P.M., Branco C., Antunes M.J. Negative impact of atrial fibrillation and pulmonary hypertension after mitral valve surgery in asymptomatic patients with severe mitral regurgitation: a 20-year follow-up. Eur. J. Cardiothorac. Surg. 2015; 48 (4): 548–55. DOI: 10.1093/ejcts/ezu511
- Lee J.S., Kim K.H., Choi J.W., Hwang H.Y., Kim K.-B. Surgical treatment of degenerative mitral valve regurgitation in the elderly: Comparison of early and long-term outcomes using propensity score matching analysis. Kor. J. Thorac. Cardiovasc. Surg. 2018; 51 (6): 367–75. DOI: 10.5090/kjtcs.2018.51.6.367
- Slivneva I.V., Sokol'skaya N.O. Three-dimensional echocardiographic model of functional mitral regurgitation. Creative Cardiology. 2019; 13 (3): 229–40 (in Russ.). DOI: 10.24022/1997-3187-2019-13-3-229-240
About the authors
- Svetlana I. Babenko, Dr. Med. Sc., Leading Researcher, orcid.org/0000-00022621-4504
- Ravil M. Muratov, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0003-3321-9028
- Anton S. Sachkov, Cand. Med. Sc., Researcher, orcid.org/0000-0002-7796-4292
- Natal'ya N. Soboleva, Cand. Med. Sc., Physician of Functional Diagnostics;
- Maksim N. Sorkomov, Cardiovascular Surgeon, orcid.org/0000-0001-7892-368х
