Mitral Valve Reconstruction Research Articles

Clinical manifestations and results of reconstructive surgeries in patients with primary and secondary mitral insufficiency

Mitral valve regurgitation is the most common disorder of the valvular heart lesions; it occurs in 10 % of the population.Mitral valve reconstruction has become a priority option for mitral regurgitation correction, due to the documented advantages, comparing with valve replacement, in terms of long-term survival, absence of valve-related side effects, and preservation of left ventricle function. Improvement of mitral valve reconstruction techniques has made almost all lesion variants (more than 95 %) suitable for reconstruction, with a 15-year freedom from reoperations in 90 % of all operated patients.Aim. To study clinical manifestations and results of reconstructive surgeries on the mitral valve in patients with primary and secondary mitral regurgitation.Materials and methods. The study is based on the analysis of clinical data of 218 patients with mitral valve insufficiency who were treated in National M. Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2010 to 01.01.2015. The average age of patients was 52.8 ± 13.0 years (16.0–78.0). The ratio of male to female patients was 151 (69.3 %) and 67 (30.7 %) cases, respectively. Acute occurrence of mitral regurgitation was observed in 10 (4.6 %) cases.Results. According to the clinical and histological causes of mitral regurgitation, we systematized and conducted a comparative analysis between groups of patients with primary (n = 174) and secondary (n = 44) mitral regurgitation. The group with primary mitral regurgitation (n = 174) in the early postoperative period was characterized by averagely shorter duration of the total time of artificial ventilation compared with the secondary genesis of mitral regurgitation. Thus, in the group of patients with secondary mitral regurgitation significantly (P = 0.003) more often there were signs of acute cardiac insufficiency. Hospital mortality for the whole group of patients was 5 (2.3 %) cases. In the group with secondary mitral regurgitation, hospital mortality was significantly higher and amounted to – 6.8 % (3 cases in 44 patients), against 1.2 % (2 cases in 174 patients) in primary mitral regurgitation.Conclusions. Primary mitral regurgitation occurs due to a violation of the anatomy of the valvular apparatus, accompanied by increased mobility of the valves (prolapse) and regurgitation. Hospital mortality in primary mitral regurgitation was 1.2 %. Survival after 6 months and by the end of 1 and 5 years was 98.8 %, 98.2 % and 97.0 %, respectively. Secondary mitral regurgitation is caused by the initial dilatation of the left ventricle with preserved anatomy of the valvular apparatus. Hospital mortality was 6.8 %. Survival rate after 6 months, by the end of 1, 3 and 5 years, was 90.9 %, 86.3 %, 77.9 % and 74.0 % respectively.

Reconstructive operations on subvalvular structures of the mitral valve during remodelling of the left ventricle. Papillary muscle interventions

The optimal treatment strategy for secondary mitral regurgitation of type IIIb (A. Carpentier classification) remains debatable. The use of a standard surgical technique for treating secondary mitral regurgitation and undersized ring annuloplasty demonstrates suboptimal results in several patients (about 30% of the patients exhibit postoperative hemodynamically significant mitral regurgitation with the absence of effective reverse remodelling of the left ventricle). Such suboptimal results are associated with the unification of only the mitral valve reconstruction technique, irrespective of the state of the left ventricle (degree of dysfunction, dilatation, tethering/tenting, and papillary muscle displacement); this is not entirely justified because of the disease complexity (valve and ventricular), and it is crucial to influence both the components of the disease. Particularly, modern researchers are inclined toward the need of using additional reconstructive interventions on the subvalvular structures that contribute to a more effective reverse remodelling of the left ventricle.Here, we present a review of recent studies on the surgical treatment of functional mitral insufficiency of type IIIb (A. Carpentier classification) with effects on the subvalvular structures (pupillary muscle relocation and approximation).Revised 19 April 2020. Revised 5 May 2020. Accepted 28 May 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

Domain gap in adapting self-supervised depth estimation methods for stereo-endoscopy

Abstract In endoscopy, depth estimation is a task that potentially helps in quantifying visual information for better scene understanding. A plethora of depth estimation algorithms have been proposed in the computer vision community. The endoscopic domain however, differs from the typical depth estimation scenario due to differences in the setup and nature of the scene. Furthermore, it is unfeasible to obtain ground truth depth information owing to an unsuitable detection range of off-the-shelf depth sensors and difficulties in setting up a depth-sensor in a surgical environment. In this paper, an existing self-supervised approach, called Monodepth [1], from the field of autonomous driving is applied to a novel dataset of stereo-endoscopic images from reconstructive mitral valve surgery. While it is already known that endoscopic scenes are more challenging than outdoor driving scenes, the paper performs experiments to quantify the comparison, and describe the domain gap and challenges involved in the transfer of these methods.

Improving Care for Patients With Degenerative Mitral Regurgitation

In this issue of The Annals of Thoracic Surgery, Brescia and colleagues1 performed an economic assessment of mitral valve reconstruction performed at a mitral reference center. In their analysis, they compared the costs of mitral valve repair for locally treated patients with those of patients who had traveled to their center for surgery. Charges, professional fees, and payments from hospital systems were used along with US Medicare estimates. Based on these data, they determined an economic benefit for patients, payer, and consequently, society (sum of patients and payer benefit).

Mitral valve surgery combined with on-pump versus off-pump myocardial revascularization: A prospective randomized analysis with midterm follow-up.

The aim of the study was to compare results off-pump coronary artery bypass (OPCAB) combined mitral valve reconstruction (MVR) with standard on-pump approach. From January 2014 to December 2017, a total of 53 patients received a combined myocardial revascularization and MVR for multivessel coronary artery disease (CAD) complicated by severe ischemic mitral regurgitation (IMR). All the subjects were divided into two groups: group I: 27 patients, received OPCAB + MVR, and group II (control group): 26 patients with on-pump myocardial revascularization (ONCAB) + MVR. The aortic cross-clamp (ACC) and cardio-pulmonary bypass (CPB) times were longer in group II, 47.0 (44.0; 55.0) vs 94.5 (89.75; 105.5) minutes, P < .05 and 70.0 (63.0; 77.0) vs 138.5 (127.0; 157.5) minutes, P < .05, respectively. Evaluation of major clinical events showed that the implementation of the off-pump stage of myocardial revascularization in patients with severe IMR did not lead to significant changes in the mortality and postoperative complications. Furthermore, its use did not affect the volume of blood loss and need for blood transfusion, the duration of mechanical ventilation, the need for inotropic therapy, as well as the duration of the patient's resuscitation and the total duration of hospitalization, with the one exception: the troponin-T level increase in the OPCAB + MVR group was less than in the ONCAB + MVR group. OPCAB combined MVR in patients with CAD and severe IMR can be performed with shorter CPB and ACC times, and lower troponin-T level after surgery, without reducing the risk of surgical complications.

Dynamic changes of mitral annulus in patients with degenerative mitral regurgitation and chronic atrial fibrillation undergoing mitral valve reconstruction.

This study was designed to assess structural and dynamic changes in the mitral annulus in patients before mitral valve reconstruction for degenerative mitral regurgitation with or without chronic atrial fibrillation. One hundred and fifty one consecutive patients undergoing mitral valve reconstruction for mitral regurgitation due to myxomatous diseasebetween July 2013 and May 2016 were included. Of these, 117 had a sinus rhythm (SR group) and 34 had chronic AF (AF group). Patients who underwent aortic surgery and were found to have no underlying cardiac valve disease nor coronary artery disease were included as the control group (n = 20).Real-time three-dimensional trans-esophageal echocardiography (3D-TEE) was used to assess mitral annulus shape, size, and movements. Annular areas in the control group were the smallest of the three groups and changed considerably through the cardiac cycle. Mean anteroposterior and intercommissural diameter measurements in theSR group were significantly larger but oscillated less than in the control group.Those diameters were the largest in the AF group and oscillated very little. Dilatation of the annulus in the AF and SR groups was accompanied by flattening and marked loss of oscillation in the height-to-intercommissural-width ratio which should peak in early systole. In patients with degenerative mitral regurgitation undergoing mitral valve surgery, preoperative chronic atrial fibrillation is associated with more progressed annular remodeling, characterized by marked enlargement of annular area, circumference, and anteroposterior diameter.

Successful Repeat Transcatheter Mitral Valve Replacement After Late Prosthesis Failure

An 80-year-old woman on oral anticoagulation therapy, with previous mitral valve reconstruction, subsequent coronary artery bypass grafting with aortic and mitral valve (29-mm Mosaic, Medtronic, Dublin, Ireland) replacement, and 10 years later, transcatheter mitral valve replacement (TMVR) with a 26

Impact of the introduction of percutaneous edge-to-edge mitral valve reconstruction on clinical practice in Germany compared to surgical valve repair

BackgroundThe introduction of percutaneous mitral valve (MV) repair had an effect on clinical practice in comparison with surgical MV repair. Complete nationwide data are useful in examining how the introduction of a new technique influences clinical practice.MethodsWe analyzed procedural numbers, patient characteristics, and in-hospital outcomes for all percutaneous edge-to-edge and surgical MV reconstruction procedures performed in Germany between 2009 and 2015.Results12,664 percutaneous edge-to-edge and 22,825 surgical MV reconstructions were recorded. Numbers increased steadily, albeit more rapidly in the percutaneous edge-to-edge group (108–4079 vs. 2923–3603 with surgical MV reconstruction). Patients with percutaneous edge-to-edge MV reconstruction were older (75.6 ± 8.8 vs 61.6 ± 13.4 years, P < 0.001) and at higher operative risk (estimated logistic EuroSCORE 13.2% vs. 4.7%, P < 0.001) compared to those undergoing surgery. However, in-hospital mortality did not differ (2.9% vs. 2.8%; P = 0.395). This was also true for the subset of 2103 patients at intermediate operative risk as defined by a logistic EuroSCORE ≥ 4% and ≤ 9%. Of note, complication rates (except acute kidney injury) were more favorable in patients undergoing percutaneous edge-to-edge reconstruction.ConclusionsPercutaneous edge-to-edge MV reconstruction has markedly changed clinical practice of MR therapy in Germany. Annual overall procedural numbers more than doubled, with a massive increase in percutaneous edge-to-edge procedures. Our data demonstrate its use mainly in high-risk patients and prove the favorable safety profile of this novel technique, with low in-hospital mortality and complication rates.

Gasparyan Method of Total Autologous Reconstruction of the Mitral Valve: Case Report

In this case report we present our first clinical experience of total autologous reconstruction of the mitral valve using the technique, described in the experimental study of Dr. Gasparyan. This is a stentless, autologous valve - a very good alternative for the prosthetic valves in those cases when the mitral valve repair is not possible and its replacement is not desirable. This technique of the mitral valve reconstruction is reproducible and 3 months follow up results are encouraging. Key Words: mitral; valve; reconstruction; mitral reconstruction; autologous pericardium

Aortic Valve Replacement with Bovine Pericardium in Patients with Aortic Valve Regurgitation.

This study aimed to analyze the early and mid-term outcomes of aortic valve replacement with bovine pericardium in the treatment of aortic valve regurgitation.From January 2015 to March 2018, 36 patients (19 men; mean ± standard deviation [SD] age, 46.70 ± 16.60 years) underwent aortic valve replacement with bovine pericardium. The bovine pericardium was intraoperatively measured and shaped using an Ozaki template, according to the shape and size of the individual patient's aortic valve leaflets. Additional procedures were performed, including ventricular septal defect repair in 5 cases, mitral valve reconstruction in 6 cases, tricuspid valve reconstruction in 6 cases, and coronary artery bypass grafting in 3 cases.There were no perioperative deaths. One elderly patient with postoperative respiratory failure recovered after symptomatic treatment. One patient with frequent ventricular tachycardia after intraoperative cardiac re-jump underwent intra-aortic balloon counterpulsation (IABP), and the IABP device was successfully removed on the second postoperative day. Within the first 6 months of follow-up, there were no death events, no reoperation events, and no additional thromboembolic events. Follow-up echocardiography was performed for 6 months, with average left ventricular ejection fraction of 62.01 ± 3.21%, mean transvalvular pressure gradient of 11.17 ± 4.90 mmHg, and mean aortic valve velocity of 1.60 ± 0.58 m/s. Compared with the preoperative transthoracic echocardiography findings, the results at the six-month follow-up were statistically significant (P < 0.05). Mild aortic valve regurgitation occurred in 2 patients (5.56%), whereas other patients had no or only minimal aortic valve regurgitation (n = 34, 94.44%). Moderate aortic valve regurgitation occurred in one patient at 9 months after the initial operation. This was found to be due to infective endocarditis, and a biological valve was finally implanted.Aortic valve replacement with bovine pericardium in the treatment of aortic valve regurgitation is feasible, and good early and mid-term results are achieved. Long-term results need to be followed up in the future.

Prognostic Model of Surgical Treatment of Severe Mitral Regurgitation at Mitral Valve Prolapse

The article presents a single-center experience of surgical treatment of patients with severe mitral regurgitation(MR) caused by mitral valve prolapse (MVP). The study is based on long-term results of reconstructive interventions on the mitral valve (MV) of the UCCC of the Ministry of Health of Ukraine. The purpose of this work is to determine the factors that influence the long-term results of surgical treatment of MR in prolapse of the mitral valve leaflets.&#x0D; Material and methods.From January 1, 2011, to January 1, 2018, 146 patients with severe MR were operated on the basis of the UCCC, which was conditioned by the prolapse of mitral valve leaflets.&#x0D; Results.Long-term results were analyzed in 95.2% of patients. The average postoperative follow-up period was 39.7 ± 19.8 months. The overall mortality rate was 1.4%. Freedom from moderate and severe MR in the remote postoperative period decreased to 94.2%, compared to the early postoperative period. Residual MR was absent in 17 (12.4%) patients. In 76 (55.5%) patients trivial MR was detected, in 36 (26.3%) there was a mild MR, in 3 (2.2%) a moderate MR. In 5 (3.6%) patients, a severe MR was detected during the observation. Using statistical methods, it was found that the anatomical variant of MVP influences the prognosis of treatment results in the long postoperative period with worse results in the group with isolated prolapse of the anterior leaflet. Also, the dependence of the results on the applied surgical techniques with better results in annuloplication using the annuloplasty rings and in the application of resection of the posterior mitral leaflet. On the basis of statistics, a prognostic model for the evaluation of MV repair results in the distant period was developed. The height of coaptation of mitral leaflets was determined as one of the indicators for predicting the results of surgical treatment of MR with MVP.&#x0D; Conclusions: 1. In most cases, a successful mitral valve repair is possible with the MVP. 2. A good immediate result does not mean keeping it in the long term. 3. The long-term results of MV reconstruction depend on the anatomical variant of the MVP, with worse results in patients with isolated prolapse of the anterior mitral leaflet. 4. The result of MV repair depends on the surgical techniques used, with better results when using the annuloplasty rings and resection of the posterior mitral leaflet. 5. The height of the coaptation of the MV leaflets is an indicator that allows predicting the outcome of surgical treatment in the long postoperative period.

4291Six-month outcomes from the multicenter, prospective study with the novel PASCAL transcatheter valve repair system for patients with mitral regurgitation in the CLASP study

Abstract Background Severe mitral regurgitation may lead to an impaired prognosis if left untreated. Transcatheter treatment options have emerged as an alternative to surgery and an adjunct to medical therapy. We report the six-month results of the PASCAL transcatheter valve repair system in treating patients with mitral regurgitation enrolled in the multicenter, prospective, single arm CLASP study. Methods The PASCAL Transcatheter Valve Repair System is a leaflet repair therapy that uses clasps and paddles to place a woven Nitinol spacer between the native valve leaflets to fill the regurgitant orifice via a transseptal approach. Eligible patients had clinically significant MR despite optimal medical therapy and were deemed candidates for transcatheter mitral repair by the local Heart Team. Safety, performance, and clinical outcomes were prospectively assessed at baseline, discharge, 30 days, and 6 months post-procedure. All major adverse events (MAE) were adjudicated by an independent clinical events committee and echocardiographic images were assessed by a core lab. The MAE rate was the primary safety endpoint, defined as the composite of cardiovascular mortality, stroke, MI, new need for renal replacement therapy, severe bleeding, and re-intervention for study device-related complications. Results Between June 2017 and September 2018, 62 patients were enrolled at 14 sites worldwide for transcatheter mitral valve reconstruction using the PASCAL system. The mean age was 76.5 years (62.9% male). All patients had MR grade ≥3+, with 59% functional, 34% degenerative, and 7% mixed etiology, and 51.6% of patients were in NYHA Class III/IV. Successful implantation of the PASCAL device was achieved in 95% of patients. At discharge, 95% of patients had MR grade ≤2+ with 81% grade ≤1+. There was one cardiovascular mortality and the MAE rate was 4.8%. At 30-day follow-up, paired analyses shows that 98% of patients had MR grade ≤2+ with 81% grade ≤1+ and 88% were in NYHA Class I/II (p&lt;0.0001). The 6MWD improved by 38.9 m (p=0.0015) and was accompanied by average improvements in KCCQ and EQ5D scores by 14.1 points (p&lt;0.0001) and 8.3 points (p=0.0028), respectively. The six-month data will be available for presentation. Conclusions In this early device experience, the PASCAL transcatheter valve repair system showed an acceptable safety profile and performed as intended in treating patients with mitral regurgitation. The PASCAL device resulted in significant MR grade reduction, which was associated with clinically and statistically significant improvements in functional status, exercise capacity, and quality of life. Continued follow-up is warranted to validate these initial promising results. Acknowledgement/Funding Edwards Lifesciences

Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature

The paper presents a rare case of successful correction of an anterior mitral leaflet perforation. A 28-years old patient was referred with progressive heart failure symptoms at 18 weeks after he had a penetrating stab wound of the right ventricle. Massive pericardial effusion with cardiac tamponade risk and severe mitral valve insufficiency were found at examination. By the time of referral, spontaneous closure of the ventricular septal defect, which is an inevitable component of the “unhappy triad”, had happened. Accurate topical ultrasound diagnosis of the intracardial lesion that resulted from the penetrating wound of the left ventricular outflow allowed for a successful urgent mitral valve reconstruction with a xenopericardial patch and the insertion of a 28 mm MedEng annuloplasty band. To prevent any future pericardial constriction, subtotal pericardectomy by Cooley was performed.Conclusion: Perioperative echocardiography and subsequent follow up by cardiologist are obligatory in all cases of precordial wounds after discharge from hospital. Timely surgery for traumatic mitral leaflet perforation allows for a successful valvuloplasty.

Transcatheter approaches for mitral valve regurgitation

Surgical repair for a longtime was and currently is regarded as the gold-standard for the treatment of mitral regurgitation (MR). With an aging population, significant MR became not only more prevalent, but also fundamental for development of transcatheter devices for patients at high surgical risk. After successful attempts in transcatheter mitral valve reconstruction two decades ago, successful transcatheter mitral valve replacement (TMVR) was performed for the first time in 2012. Currently several repair-systems are available and a couple of them proved to be even superior to conventional surgery in selected patient populations. Since the mitral valve (MV) apparatus is a complex anatomical structure, progress in development of TMVR took longer than in transaortic valve replacement (TAVR). We aim at giving insight in current standards of transcatheter treatments for severe MR by critically reviewing the latest literature.

Entire mitral reconstruction with porcine extracellular matrix in an acute porcine model

ObjectiveThe objective of our study was to investigate the feasibility of reconstructing the entire mitral valvular and subvalvular apparatus in pigs using a modified tube graft design made of 2-ply small intestinal submucosa extracellular matrix. MethodsThe reconstructions were performed in an acute 80-kg porcine model with 8 pigs, each acting as its own control. A modified tube graft was designed from a sheet of 2-ply small intestinal submucosa extracellular matrix. Before and after mitral valve reconstruction, echocardiography was used to assess mitral regurgitation, left ventricular outflow tract obstruction due to systolic anterior motion, mitral stenosis, leaflet mobility, and leaflet geometry. ResultsThe reconstructed mitral valves were fully functional without any observable echocardiographic signs of regurgitation. We did not observe any left ventricular outflow tract obstruction due to systolic anterior motion nor any mitral valve stenosis, despite a diminished septal-lateral distance after reconstruction. The reconstruction had a reduced tenting area, a reduced coaptation length (9.6 ± 1.7 mm vs 7.9 ± 1.0 mm, P = .010, diff = −1.7 mm, 95% confidence interval, −3.1 to −0.4 mm), and atrial bending of both leaflets. ConclusionsIn this acute porcine study, entire mitral valvular and subvalvular apparatus reconstruction using a modified tube graft design made from 2-ply small intestinal submucosal extracellular matrix was feasible. The 2-ply small intestinal submucosa extracellular matrix could withstand the pressure exerted by the left ventricle without any signs of tearing or rupture. These promising results warrant further assessment of both the annular geometry and the long-term durability.

Six-month Outcomes from the Multicenter, Prospective Study with the Novel PASCAL Transcatheter Valve Repair System for Patients with Mitral Regurgitation in the CLASP Study

Severe mitral regurgitation (MR) may lead to an impaired prognosis if left untreated. Transcatheter treatment options have emerged as an alternative to surgery and an adjunct to medical therapy. We report the six-month results of the PASCAL transcatheter valve repair system in treating patients with MR enrolled in the multicenter, prospective, single arm CLASP study. The PASCAL system is a leaflet repair therapy that uses clasps and paddles to place a woven Nitinol spacer between the native valve leaflets to fill the regurgitant orifice via a transseptal approach. Eligible patients had clinically significant MR despite optimal medical therapy and were deemed candidates for transcatheter mitral repair by the local Heart Team. All major adverse events (MAE) were adjudicated by an independent clinical events committee and echocardiographic images were assessed by a core lab. The MAE rate was defined as the composite of cardiovascular mortality, stroke, MI, new need for renal replacement therapy, severe bleeding, and re-intervention for study device-related complications. 62 patients were enrolled worldwide for transcatheter mitral valve reconstruction using the PASCAL system. The mean age was 76.5 years. All patients had MR grade ≥3+ and 51.6% of patients were in NYHA Class III/IV. Successful implantation of the PASCAL device was achieved in 95% of patients. At discharge, 95% of patients had MR grade ≤2+ with 81% grade ≤1+. The MAE rate was 4.8%. At 30-day follow-up, 98% of patients had MR grade ≤2+ with 81% grade ≤1+ and 88% were in NYHA Class I/II (p

MITRAL VALVE GEOMETRY IN HYPERTROPHIC CARDIOMYOPATHY AND ITS ROLE IN THE DEVELOPMENT OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION

Aim. To evaluate structural features of the mitral valve (MV) in patients with left ventricular hypertrophy (LVH) and to identify characteristics of MV structural remodeling in hypertrophic obstructive cardiomyopathy (HOCM) patients using three-dimensional MV quantification analysis.Material and Methods. The study included 48 patients with HOCM and 15 patients with arterial hypertension and LVH. All patients underwent standard echocardiography and real-time 3D transesophageal echocardiography, followed by MV reconstruction with quantitative analysis. Quantitative analysis of MV included assessment of the mitral annulus and cusps.Results. Differences in characteristics of three-dimensional MV model between patients with HOCM and arterial hypertension and LVH were identified. In patients with HOCM, the height of the fibrous ring of the MV was increased compared to that in patients with arterial hypertension (8.00±1.72 mm vs. 5.99±1.95 mm; p=0.02). Mitral annular height (r=-0.55; p=0.02) and area(3D) (r=-0.30; p=0.04) correlated with peak LV outflow tract (LVOT) gradient. MV nonplanarity index was higher in HOCM patients (2.37±0.47 units vs. 1.73±0.62 units; p=0.02). Mitral annular maximal velocity correlated with peak (r=0.48, p=0.002) and mean (r=0.47, p=0.01) LVOT gradients. Anterior (6.40±2.04 sm2 vs. 5.07±1.04 sm2 ; p&lt;0.05) and posterior (6.61±2.01 см2 vs. 5.27±1.23 см2 ; p=0.006) cusp areas, total cusp area (13.01±3.54 sm2 vs. 10.34±1.82 sm2 ; p=0.008), and total cusp area to annular area ratio (1.31±0.2 units vs. 1.15±0.09 units; р=0.01) had higher values in patients with HOCM. Correlation existed between anterior leaflet length and peak LVOT gradient (r=-0.45; p=0.01). Patients with HOCM had increased anterior leaflet angle compared to patients with arterial hypertension and LVH (32.13±9.21° vs. 24.86±4.45°; р=0.04).Conclusion. Compared to patients with arterial hypertension and LVH, patients with HOCM experienced more pronounced MV annular remodeling presented as an increase in the annular height, which was accompanied by an increase in the cusp areas and the anterior leaflet angle. In patients with HOCM, the annular area and the maximum mitral annular velocity correlated with LVOT gradient.

MITRAL VALVE GEOMETRY IN HYPERTROPHIC CARDIOMYOPATHY AND ITS ROLE IN THE DEVELOPMENT OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION

Aim. To evaluate structural features of the mitral valve (MV) in patients with left ventricular hypertrophy (LVH) and to identify characteristics of MV structural remodeling in hypertrophic obstructive cardiomyopathy (HOCM) patients using three-dimensional MV quantification analysis.Material and Methods. The study included 48 patients with HOCM and 15 patients with arterial hypertension and LVH. All patients underwent standard echocardiography and real-time 3D transesophageal echocardiography, followed by MV reconstruction with quantitative analysis. Quantitative analysis of MV included assessment of the mitral annulus and cusps.Results. Differences in characteristics of three-dimensional MV model between patients with HOCM and arterial hypertension and LVH were identified. In patients with HOCM, the height of the fibrous ring of the MV was increased compared to that in patients with arterial hypertension (8.00±1.72 mm vs. 5.99±1.95 mm; p=0.02). Mitral annular height (r=-0.55; p=0.02) and area(3D) (r=-0.30; p=0.04) correlated with peak LV outflow tract (LVOT) gradient. MV nonplanarity index was higher in HOCM patients (2.37±0.47 units vs. 1.73±0.62 units; p=0.02). Mitral annular maximal velocity correlated with peak (r=0.48, p=0.002) and mean (r=0.47, p=0.01) LVOT gradients. Anterior (6.40±2.04 sm2 vs. 5.07±1.04 sm2 ; p&lt;0.05) and posterior (6.61±2.01 см2 vs. 5.27±1.23 см2 ; p=0.006) cusp areas, total cusp area (13.01±3.54 sm2 vs. 10.34±1.82 sm2 ; p=0.008), and total cusp area to annular area ratio (1.31±0.2 units vs. 1.15±0.09 units; р=0.01) had higher values in patients with HOCM. Correlation existed between anterior leaflet length and peak LVOT gradient (r=-0.45; p=0.01). Patients with HOCM had increased anterior leaflet angle compared to patients with arterial hypertension and LVH (32.13±9.21° vs. 24.86±4.45°; р=0.04).Conclusion. Compared to patients with arterial hypertension and LVH, patients with HOCM experienced more pronounced MV annular remodeling presented as an increase in the annular height, which was accompanied by an increase in the cusp areas and the anterior leaflet angle. In patients with HOCM, the annular area and the maximum mitral annular velocity correlated with LVOT gradient.

Successful Hybrid Minimally Invasive Revascularization and Mitral Valve Reconstruction in a High-risk Patient.

Successful Hybrid Minimally Invasive Revascularization and Mitral Valve Reconstruction in a High-risk Patient.

Three-Dimensional Reconstruction of Mitral Valve by Transesophageal Echocardiography.

Three-Dimensional Reconstruction of Mitral Valve by Transesophageal Echocardiography.