Meijerink, F. (Frank) (2017) Three-Dimensional Quantitative Mitral Valve Analysis After Undersized Annuloplasty For Ischemic Mitral Regurgitation. thesis, Medicine.
Full text available on request.Abstract
BACKGROUND Mitral Valve (MV) Repair for Ischemic Mitral Regurgitation (IMR) is characterized by high recurrence rates, up to 30% after six months. Previous studies have shown that the preoperative P3 tethering angle is a strong predictor for recurrent IMR, 6 months after annuloplasty and that three-dimensional (3D) predictive models are stronger than two-dimensional (2D) predictive models. The effect of reduction annuloplasty has not been studied with 3D transesophageal echocardiography (TEE). With this study we aim to (1) determine the effect of reduction annuloplasty on 3D echocardiographic annular and leaflet tethering parameters and (2) to compare these parameters between patients that do and do not develop recurrent IMR 6 months after annuloplasty. METHODS In this study 35 patients were included. All had severe IMR eligible for MV repair. There was no echocardiographic evidence for structural (chordal or leaflet) MV disease or papillary muscle (PM) rupture. All patients underwent MV repair with an undersized annuloplasty ring. For all patients pre- and post-repair 3D TEE images were obtained. Six months after repair IMR grade was assessed using 2D transthoracic echocardiography to determine recurrent IMR (≥grade 2). All 3D images were processed and analyzed in a specialized software workstation, resulting in a 3D model of the MV in mid-systole. This model allowed for quantitative analysis using MATLAB. This way annular and leaflet tethering variables were measured and statistical analysis was performed. RESULTS Nine patients (25.7%) showed recurrent IMR after 6 months. The A1, A2, P1, P2 and P3 tethering angles were significantly higher post-repair. The posterior tethering angles showed the highest increase (>20°). The pre-repair P2 and P3 tethering angles were significantly different between non-recurrent and recurrent groups. Post-repair there was no difference in tethering angles between the two groups. CONCLUSION Three-dimensional MV analysis shows that undersized annuloplasty exacerbates global leaflet tethering. Pre-repair the tethering pattern is different between non-recurrent and recurrent IMR patients, post-repair it is not. Although prerepair MV tethering predicts recurrent IMR after annuloplasty, post-repair MV tethering does not. The results indicate that subvalvular mechanisms and geometry play a pivotal role in the postoperative development of recurrent IMR after undersized annuloplasty.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | First supervisor: and Kallenberg, Cees G.M. MD and Second supervisor: and Bouma, Wobbe MD and Department of Cardiothoracic Surgery, University and Medical Centre Groningen |
| Supervisor name: | External supervisor: and Gorman, Robert C. MD and Gorman Cardiovascular Research Group, University of and Pennsylvania |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/536 |
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