Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping
Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping
复制标题
DOI：
10.1093/icvts/ivx033
复制
发表时间：
2017-06-01
影响因子：
--
通讯作者：
Sawa, Teiji
中科院分区：
文献类型：
--
作者：
Akiyama, Koichi;Nakamura, Naotoshi;Sawa, Teiji
目的：我们评估了接受二尖瓣修复术或生物瓣置换术的患者左心室血流中的涡流模式和能量损失，方法：分别在15例和17例接受修复术和置换术的患者术前和术后进行矢量流标测。术前测量所有患者的二尖瓣间隔角。统计学分析了修复组中涡流模式或能量损失变化（ELC）与瓣环成形环或生物瓣膜尺寸或二尖瓣叶切除效果之间的关系。分别在2例和16例接受修复和置换的患者中观察到异常涡流模式。置换组的ELC（196.6 +/- 180.8）显著高于修复组（71.9 +/- 43.9）。在修复组中，正常涡旋模式患者的术前二尖瓣-间隔角（79.2度± 3.4度）显著大于异常涡旋模式患者（67.5度± 3.5度）。瓣膜成形环和生物瓣膜尺寸对涡流模式和ELC的影响，以及二尖瓣切除术（80.4 +/- 56.3）和尊重（无瓣叶切除）（53.8 +/- 28.4）对修复组ELC的影响，均无显著差异。结论：二尖瓣置换术改变了心室内涡流模式，增加了流动能量损失。小的二尖瓣-间隔角是二尖瓣修复术后异常涡流模式的危险因素。
OBJECTIVES: We assessed vortex patterns and energy loss in left ventricular flow in patients who underwent mitral valve repair or replacement with bioprosthetic valves.METHODS: Vector flow mapping was performed before and after the procedure in 15 and 17 patients who underwent repair and replacement, respectively. The preprocedure mitral-septal angle was measured in all patients. Relationships between vortex patterns or energy loss change (ELC) and annuloplasty ring or bioprosthetic valve sizes or the effect of mitral leaflet resection in the repair group were statistically analysed.RESULTS: Normal vortex patterns were observed in 13 and 1 patients who underwent repair and replacement, respectively. Abnormal vortex patterns were observed in 2 and 16 patients who underwent repair and replacement, respectively. ELC was significantly higher in the replacement group (196.6 +/- 180.8) than in the repair group (71.9 +/- 43.9). In the repair group, preoperative mitral-septal angles in patients with normal vortex patterns (79.2 degrees +/- 3.4 degrees) were significantly larger than those in patients with abnormal vortex patterns (67.5 degrees +/- 3.5 degrees). No significant differences were observed in the effects of annuloplasty ring and bioprosthetic valve sizes on vortex patterns and ELC, and in the effect of mitral valve resection (80.4 +/- 56.3) and respect (without leaflet resection) (53.8 +/- 28.4) on ELC in the repair group.CONCLUSIONS: Mitral valve replacement alters the intraventricular vortex pattern and increases flow energy loss. A small mitral-septal angle is a risk factor for abnormal vortex patterns after mitral valve repair surgery.