MO64. Evaluation of Rheumatic Mitral Valve Repair by Computed Tomography Imaging: Insight into the Interaction between Valve Configuration and Hemodynamic in Mitral Stenosis
Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University
Shanghai, Shanghai
China - Contact Me
-Dr Tianyang Yang is currently the resident cardiac surgeon of Shanghai Chest Hospital，he is specialized in heart valve repair surgery including aortic valve and mitral valve repair.
-Coferences participations include:
• AATS Aortic Symposium, New York, 2018, e-poster: Analysis of aortic root configuration with multi-sliced computed tomography: implication for valve sparing aortic root reconstruction
• EACTS Aortic valve repair summit, Paris, 2018, e-poster: Aortic Root Assessment With ECG-gated Multi-sliced Computed Tomography in Chinese Population
• EACTS Aortic valve repair summit, Brussel, 2019, Participation
• Taipei valve summit, online, 2022, Presentation, The Functional Evidence of SCORE Procedure - How to Get Rheumatic Mitral Repair
- Featured publised papers:
(1) Lijian Xu; Tianyang Yang; Lekang Yin; Ye Kong; Yuri Vassilevski; Fuyou Liang ; Numerical Simulation of Blood Flow in Aorta with Dilation: A Comparison between Laminar and LES Modeling Me thods, Computer Modeling in Engineering & Sciences, 2020, 124(2): 509-526
(2) Tianyang Yang; Haini Wen; Ismail El-Hamamsy; Qiming Ni; Yanbin Sun; Dan Zhu ; Relationship Between Leaflets and Root in Normal Aortic Valve Based on Computed Tomography Imaging: Implication for Aortic Valve Repair, Frontier in cardiovascular medicine, 2021, 8(731440)
- His interest is focused on heart valve imaging and its utility in guiding and assessing valve repair procedure and valvular hemodynamics in the simulated settings.
Description
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.