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Comparative Study
. 2015 Jul-Sep;30(3):325-34.
doi: 10.5935/1678-9741.20140082.

Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair

Marco Antônio Vieira Guedes  1 , Pablo Maria Alberto Pomerantzeff  1 , Carlos Manuel de Almeida Brandão  1 , Marcelo Luiz Campos Vieira  1 , Flávio Tarasoutchi  1 , Pablo da Cunha Spinola  1 , Fábio Biscegli Jatene  1
Affiliations
Comparative Study

Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair

Marco Antônio Vieira Guedes et al. Rev Bras Cir Cardiovasc. 2015 Jul-Sep.

Abstract
in English, Portuguese

Introduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.

Objective: To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.

Methods: Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.

Results: There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.

Conclusion: Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

Introdução: A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém, a literatura é escassa em relação ao comportamento do anel mitral após a plástica mitral sem utilização de anéis protéticos.

Objetivo: Realizar a análise morfofuncional do anel mitral de indivíduos submetidos à plastia valvar mitral pela Técnica de Duplo Teflon, sem utilização de anel protético, por meio da ecocardiografia tridimensional em tempo real.

Métodos: Foram incluídos 14 pacientes com insuficiência mitral mixomatosa submetidos à plástica mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato, 6 meses e 1 ano. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante P<0,05.

Resultados: Não houve óbito, reoperação por disfunção valvar, tromboembolismo ou endocardite durante o estudo. A planimetria posterior do anel mitral demostrou uma redução significativa (P<0,001) no pós-operatório imediato, que se manteve estável durante o estudo, apresentando redução média de 25,8% com 1 ano em relação ao pré-operatório. Houve uma redução significativa dos diâmetros ântero-posterior e médio-lateral no pós-operatório imediato (P<0,001), porém, houve um aumento significativo no diâmetro médio-lateral entre pós-operatório imediato e 1 ano. Não houve diferença na variação da área interna mitral ao longo do estudo.

Conclusão: A anuloplastia segmentar reduziu significativamente o componente posterior do anel mitral, permanecendo estável no período de um ano. A variação da área valvar durante o ciclo cardíaco permaneceu estável durante o estudo.

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Figures

Fig. 1
Fig. 1
Intraoperative aspect of the mitral valve after completion of the mitral valve repair technique “Double Teflon”. We can observe the pledgets anchored in Teflon strips and the suture edge to edge of the cusps.
Fig. 2
Fig. 2
Illustration of the echocardiographic variables. Anterior perimeter=red line; posterior perimeter=blue line; anteroposterior diameter=green line; mediolateral diameter=yellow line. Ant=anterior; Post=posterior; CAL=anterolateral commissure, CPM=posteromedial commissure). The white line shows the line of valve coaptation.
Fig. 3
Fig. 3
Evolution of the circumference of the mitral valve annulus during the study. Values =mean±standard deviation. *P<0.05 compared to the immediate postoperative period.
Fig. 4
Fig. 4
Evolution of the anterior perimeter of the mitral valve annulus during the study. Values =mean±standard deviation. *P<0.05 compared to the immediate postoperative period.
Fig. 5
Fig. 5
Evolution of the posterior perimeter of the mitral valve annulus during the study. Values =mean±standard deviation. *P<0.05 compared to the immediate postoperative period.
Fig. 6
Fig. 6
Evolution of antero-posterior diameter of the mitral valve annulus during the study. Values =mean±standard deviation. *P<0.05 compared to the immediate postoperative period.
Fig. 7
Fig. 7
Evolution of the medial-lateral diameter of the mitral valve annulus during the study. Values =mean±standard deviation. *P<0.05 compared to the immediate postoperative period.
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