ABSTRACT
Objective To study the morphologic and functional changes of the aortic‐mitral valve coupling ( AMC) after surgical aortic valve replacement ( SAVR) or transcatheter aortic valve implantation ( T AVI ) in patients with severe aortic stenosis ( AS) using three‐dimensional transesophageal echocardiography ( 3D‐T EE) . Methods Ninty‐three severe AS patients were chosed as AS group in which 43 cases underwent SAVR and 50 cases underwent T AVI . T EE was performed before and after operation . T hirty‐one age‐and gender‐matched patients who underwent 3D‐T EE for exclusion of intracardiac thrombus were selected as control group . Cardiovascular quantitative analysis software was used to measure the parameters of aortic valve ,mitral valve and AMC in the the control group ,the SAVR group and the T AVI group before and after operation . Results ① Compared with control group ,the antero posterior ( AP ) diameter of mitral value in AS group increased ,the ellipticity of mitral valve decreased ,the height of the mitral annulus increased ( all P＜ 0 .05 ) . T he open area of aortic valve decreased ,the aortic regurgitation area ,aortic regurgitant flow velocity and the diameter of the aortic annulus increased( all P ＜0 .05) . T here was no statistical difference in aortic‐mitral valvular angle ( AM A ) and other parameters( all P ＞0 .05) . ②After SAVR ,the anterolateral‐posteromedial diameter ,AP diameter ,perimeter and area of mitral valve decreased ,the ellipticity of mitral valve increased( all P ＜0 .05) . T he aortic valve opening area increased ,the aortic regurgitation area and aortic regurgitant flow velocity decreased ( all P ＜ 0 .05 ) . T here was no statistical difference in AM A and other parameters( all P ＞0 .05) . ③After TAVI ,the AP diameter ,height , perimeter and area of mitral valve decreased ,the ellipticity of mitral valve increased ( all P ＜ 0 .05 ) . The aortic valve opening area increased ,the aortic regurgitation area ,aortic regurgitant flow velocity and the diameter of the aortic annulus decreased ( all P ＜ 0 .05 ) . T here was no statistical difference in AM A and other parameters( all P ＞0 .05) . Conclusions After SAVR and T AVI ,the anatomy and function of AMC in patients with severe AS changed to varying degrees after operation . It demonstrates that the impacts of both AS and repairment of AS on the mitral valve were . In addition ,after SAVR and T AVI ,the geometry and function of aortic and mitral valves of the patients recovered to some degrees .
ABSTRACT
Objective To evaluate the feasibility and accuracy of mitral valve prolapse( M VP) model made by three‐dimensional( 3D) printing based on three‐dimensional transesophageal echocardiography ( 3D‐T EE) data and the application value for mitral valvuloplasty . Methods 3D‐T EE volumetric data of 28 patients with M VP were acquired and postprocessed ,13 patients underwent mitral valve replacement and 15 patients underwent mitral valvuloplasty . A flexible material was used to made the valve 3D model by molding . T he areas of M VP identified by models were compared with surgical findings ,the circumference and the length and thickness of anterior and posterior mitral leaflets obtained from the valve specimens and the models were compared in the mitral valve replacement group . T he diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,annulus area ,height of prolapsed leaflet and area of prolapsed leaflet were measured from 3D models and 3D‐T EE images in mitral valvuloplasty group . Surgical simulations were performed on the 3D models of the mitral valvuloplasty group ,and the water injection test was used to evaluate the surgical results and compared with the surgical results . Results 3D‐T EE volumetric data were successfully postprocessed and made as 3D M VP models in all patients . T he consistency of M VP location based on 3D models and surgical findings was 0 .92 . T he differences between the mitral valve replacement group and mitral valvuloplasty group were not significant ( P＞ 0 .05 ) . A simulation valvuloplasty was successfully performed on the 3D model in mitral valvuloplasty group ,2 patients underwent mitral valve replacement after water injection test . T he remaining 3D models successfully simulated the operation . Conclusions The M VP model made by 3D‐T EE and 3D printing technique has high feasibility and accuracy ,w hich may be promising for the mitral valvuloplasty of M VP .