P853Does mitral valve quantification give additional information for mitral valve repair compared to three dimensional transesophageal echocardiography images and simple three dimensional measurements?


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Abstract

Purpose: Mitral valve (MV) quantification by Philips Mitral Valve Quantification (MVQ) software provides a lot of information about MV geometry. We analysed these data in respect of providing any additional information for MV repair. Questions were: which parameters forebode unsuccessful repair; predict quantitatively resection of any part(s) of leaflets and the size of the ring.Methods: Twenty five mitral valves with severe insufficiency was evaluated by Philips MVQ software between 09 2009 – 09 2010. Every patient underwent MV surgery (21 repairs and 4 replacements). Intraoperative 3D TEE was performed for all patients to facilitate surgery. MV quantification was carried out after surgery. 3D images, surgical findings, results and MVQ data were compared. We used paired t test to compare numeric parameters between the groups and linear regression analysis for the correlation between the ring size and the size of the annulus.Results: MVQ model accorded exactly surgical findings in every case. In two cases only MVQ model visualised small prolapses in the P3 and A3 scallops beyond a huge P2 prolapse. 5 patients had ischemic annular dilatation, 5 patients had Barlow disease and 15 patients had fibroelastic deficiency. In some cases, definition of annular points were doubtful with MVQ software, but annular diameters correlated well (R2=0,9) with 3DQ measurements. Tenting height was significantly greater (13,5 mm v 5,9 mm p: 0,049), tenting volume was almost significantly greater (3,7ml v. 1,34ml p: 0,07) in the replacement group. Neither leaflets length and area nor billowing height and volume predict necessity of resection of any part(s) of leaflets. Decision of scallop resection was based on morphological findings. Only P2 or P1-P2 prolapses were resected. Any other prolapsing scallops were anchored by artificial chorda. There was no correlation (r=0) between annular area or length and the size of the ring. The ring size was depended on the intertrigonal distance and the existing pathology (undersizing, oversizing). Only trivial regurgitation was detected after the surgery and during the 7-19 months follows up.Conclusion: MVQ model exactly corresponds to surgical finding and it can reveals the extension of disease and shows small prolapses that difficult to notice otherwise. In this manner, it draws attention to complicated repair. Huge tenting can predict failure of repair. Most of numeric parameters don't give additional information compared to 3D images with simple 3DQ measurements.

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