Evaluation of rheumatic mitral valve repair by Computed tomography imaging: Insight into the interaction between valve configuration and hemodynamic in mitral stenosis
Presented During:
Friday, May 5, 2023: 7:40AM - 7:45AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO064
Submission Type:
Abstract Submission
Authors:
Tianyang Yang (1), Busheng Zhang (1), dan zhu (2), Fang Yu (3), Xu Meng (4)
Institutions:
(1) Shanghai Chest Hospital, Shanghai, China, (2) Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, NA, (3) Westchester Medical Center New York Medical College, New York, NY, (4) Beijing Anzhen Hospital, Beijing
Submitting Author:
Tianyang Yang
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Shanghai Chest Hospital
Shanghai Chest Hospital
Co-Author(s):
Busheng Zhang
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Shanghai Chest Hospital
Shanghai Chest Hospital
dan zhu
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Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine
Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine
Fang Yu
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Westchester Medical Center New York Medical College
Westchester Medical Center New York Medical College
Xu Meng
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Beijing Anzhen Hospital
Beijing Anzhen Hospital
Presenting Author:
Tianyang Yang
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Shanghai Chest Hospital
Shanghai Chest Hospital
Abstract:
Objective:Altered Valve configuration is closely related to disturbed hemodynamic in rheumatic mitral stenosis. Mitral valve repair has been shown to restore the valve function with improved transvalvular hemodynamics. We tried to explore the relationship between postoperative functional improvement and valve morphology changes with CT imaging.
Method:A total of 32 consecutive patients (age 47.0±9.6 years, 24 female) who underwent valve repair for rheumatic mitral stenosis from 2020 to 2022 were enrolled. An ECG-gated CT were performed both pre- and post-operatively for 2-dimensional measurements of valve geometry at diastole and systole. In addition to regurgitation degree, coaptation height, tenting depth and anterior leaflet length/short annulus axis ratio were assessed for mitral closure. For mitral opening, leaflet mobility, effective orifice area (EOA) and heart rate indexed transmitral gradient were analyzed with validation of echocardiography. Additionally, tapering index was calculated to evaluate the 3-dimensional(3D) configuration in mitral stenosis and its correlation with transmitral gradient was further studied before and after valve repair.
Results:After valve repair, CT image analysis demonstrated increase in coaptation height (5.8±2.1mm vs. 8.0±2.1mm, P<0.01), tenting depth (5.0±1.8mm vs. 7.6±1.9mm, P<0.01) and the augmented anterior leaflet length/short annulus axis ratio (0.95±0.10 vs. 1.17±1.26, P<0.01) at systole. Post repair group showed reduced mitral regurgitation (1.5±1.1 vs. 1.1±0.6, P<0.05). At systole, both increasing anterior and posterior leaflet to annulus distance (16.3±3mm vs. 21.5±3.7mm, 11.4±3.3mm vs. 14.4±2.9mm, both P<0.01) were associate with improved leaflet mobility which subsequently lead to an enlarged CT-derived EOA (1.4±0.5cm2 vs. 2.6±0.4 cm2, P<0.01) and lower heart rate indexed transmitral gradient (8.5±3.9mmHg vs. 2.8±1.1mmHg, P<0.01). Tapering index showed strong correlation with transmitral gradient (r=0.52, P=0.001). The postoperative reduced tapering index (0.9±0.2 vs. 0.5±0.8, P<0.01) corresponded to the structural transformation of stenotic mitral valve from pre-repair flat plate shape to post-repair tubular shape.
Conclusion: Improved valve configuration after valve repair for rheumatic mitral stenosis is directly associated with better transmitral hemodynamic. CT-derived 3D parameter might be a useful adjunct to provide insight into the relations between valve structure, pressure, and flows.
Method:A total of 32 consecutive patients (age 47.0±9.6 years, 24 female) who underwent valve repair for rheumatic mitral stenosis from 2020 to 2022 were enrolled. An ECG-gated CT were performed both pre- and post-operatively for 2-dimensional measurements of valve geometry at diastole and systole. In addition to regurgitation degree, coaptation height, tenting depth and anterior leaflet length/short annulus axis ratio were assessed for mitral closure. For mitral opening, leaflet mobility, effective orifice area (EOA) and heart rate indexed transmitral gradient were analyzed with validation of echocardiography. Additionally, tapering index was calculated to evaluate the 3-dimensional(3D) configuration in mitral stenosis and its correlation with transmitral gradient was further studied before and after valve repair.
Results:After valve repair, CT image analysis demonstrated increase in coaptation height (5.8±2.1mm vs. 8.0±2.1mm, P<0.01), tenting depth (5.0±1.8mm vs. 7.6±1.9mm, P<0.01) and the augmented anterior leaflet length/short annulus axis ratio (0.95±0.10 vs. 1.17±1.26, P<0.01) at systole. Post repair group showed reduced mitral regurgitation (1.5±1.1 vs. 1.1±0.6, P<0.05). At systole, both increasing anterior and posterior leaflet to annulus distance (16.3±3mm vs. 21.5±3.7mm, 11.4±3.3mm vs. 14.4±2.9mm, both P<0.01) were associate with improved leaflet mobility which subsequently lead to an enlarged CT-derived EOA (1.4±0.5cm2 vs. 2.6±0.4 cm2, P<0.01) and lower heart rate indexed transmitral gradient (8.5±3.9mmHg vs. 2.8±1.1mmHg, P<0.01). Tapering index showed strong correlation with transmitral gradient (r=0.52, P=0.001). The postoperative reduced tapering index (0.9±0.2 vs. 0.5±0.8, P<0.01) corresponded to the structural transformation of stenotic mitral valve from pre-repair flat plate shape to post-repair tubular shape.
Conclusion: Improved valve configuration after valve repair for rheumatic mitral stenosis is directly associated with better transmitral hemodynamic. CT-derived 3D parameter might be a useful adjunct to provide insight into the relations between valve structure, pressure, and flows.
Mitral Conclave:
Rheumatic Mitral Valve Disease
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