Predicting systolic anterior motion of the mitral valve. Prevention of systolic anterior motion based on preoperative echocardiographic measurements in patients undergoing mitral valve plasties.

Hutten, E.M. (2014) Predicting systolic anterior motion of the mitral valve. Prevention of systolic anterior motion based on preoperative echocardiographic measurements in patients undergoing mitral valve plasties. thesis, Medicine.

Text HuttenEM.pdf Restricted to Registered users only Download (2MB)

Abstract

Background: Systolic anterior motion of the mitral valve leaflets is a common potential life-threatening complication after mitral valve plasty in patients with mitral insufficiency. Despite several techniques designed to avert this development, it still occurs in 6.6% to 9.8% of the cases. Objectives: We set out to determine if transthoracal echocardiography in patients with hypertrophic cardiomyopathy could assist in finding high-risk patients for development of systolic anterior motion. Methods: Fifty-three patients with hypertrophic cardiomyopathy were included. Data were collected by retrospectively analysing echocardiographic images. Based on literature and pathophysiology of systolic anterior motion two variables were postulated which were expected to have a predictive value – when combined – for presence of systolic anterior motion: the aortic-mitral angle and the theoretically coaptation length in maximal and symmetrical coaptation. De latter was calculated based on the measured anterior leaflet length, posterior leaflet length and septolateral annular Dimension. Predictors of the presence of systolic anterior motion were indentified using multiple logistic regression analyses. Results: Of 53 patients, 18 had systolic anterior motion. The difference in aortic-mitral angle reached significance with 108.61 ± 2.96 in the group with systolic anterior motion comparing to 117 ± 2.51 in the group without (P = 0.023). The theoretically coaptation length was significantly bigger in the group with systolic anterior motion (14.9 ± 14.6) compared to 10.2 ± 13.3 in the group without (P = 0.039). Univariate predictors of the phenomenon included the aortic-mitral angle (OR 0.948, 95% CI 0.90-1.00; P = 0.032), the aortic-mitral angle<120° (OR 5.333, 95% CI 1.282-22.192, P = 0.021) and the theoretically coaptation length (OR 1.185; 95% CI 1.009-1.391, P = 0.019).The combination of the length and the aortic-mitral angle as categorical variable showed to be the best combination for predicting systolic anterior motion after multivariate regression analysis. Conclusion: Risk estimations for finding systolic anterior motion can be made based on several measurements made by transthoracal echocardiography. The combination of a small aortic-mitral angle and a longer theoretically coaptation length in maximal and symmetrical coaptation significantly increases the risk for systolic anterior motion.

Item Type:	Thesis (Thesis)
Supervisor name:	Grandjean, prof. J.G. and Department of Thoracic Surgery and Medisch Spectrum Twente and Enschede
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:59
Last Modified:	25 Jun 2020 10:59
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1979

Actions (login required)

View Item