Utility Of Real-time Three-dimensional Transesophageal Echocardiography And Speckle Tracking Imaging In Mitral Valvuloplasty

PartI Research the application of three-dimensional transesophageal echocardiographyin mitral valvuloplastyObject: Research the value that RT-3D TEE is applied to the mitral valvuloplasty.Materials and methods: From March2011to December2012, take thirty patients whowere diagnosed with mitral regurgitation in our hospital undergoing the mitral vavle repair.Apply with American Philips IE33Ultrasound, equipped with x7-2t3D matrix-array probe.Firstly collect the views with the routine two-dimensional transesophageal echocardiographyexamination, which include mid-esophageal level of (0°) five-chamber view-A1,P1;mid-esophageal four-chamber view-A2,P2; deep esophageal short four-chamber view-A3,P3;mid-esophageal left ventricular long axis plane（120°～160°）shows A2,P2; mid-esophagealthe two-chamber view（90°）shows-A1,P3. Collect the standard views and reserve them.Then to take the real-time three-dimensional views including live3D﹑Full Volume﹑3DZOOM and so on. Comparison of RT-3D TEE and2D TEE accuracy of mitralinsufficiency etiology and lesion locations.Result: RT-3D TEE and2D TEE evaluate of mitral regurgitation etiology, there are nodifferences. When they evaluate the change of the mitral valve prolapse on the anteriorleaflet,their accuracy are81.8%and72.7%, P>0.05there are no significant differences;When they evaluate the change of the posterior mitral valve prolapse whose accuracy are90.5%and81.0%（P<0.05）; in the evaluation of mitral valve multiple regional disease,their accuracy are85.7%and78.6%, the differences are significant; the evaluation of therupture of chordae tendineae, their accuracy are94.7%and84.2%, the differences aresignificant (p<0.05）.Conclusions: Both RT-3D TEE and2D TEE are accurately in the evaluation of mitralregurgitation etiology preoperative; the accuracy of mitral vavle prolapse and lesionseverity，RT-3D TEE is better than2D TEE. Part II Evaluation of left ventricular function in patients with mitral valvuloplastyusing speckle tracking imagingObject: Using two-dimensional speckle tracking imaging technology (2D-STI) to measureleft ventricular myocardial strain of each segments of mitral valvuloplasty in patients, and toexplore the clinical value of2D-STI quantitative evaluation of cardiac function in patientswith mitral valve surgery.Materials and methods: Take twenty five patients from March2011to December2012inour hospital diagnosed with mitral insufficiency and successful undergoing of mitral valverepair, divided into preoperative (group A), a week after operation (group B),6months afteroperation (group C) of three groups; select25healthy control group﹙group N﹚. Thenmake the routine examination using PHILIPS IE33ultrasound. To measure the LAD、LVIDd from the left ventricular long axis；measurement of LVEDV、LVESV、LVEF、LVSV、FS using the Simpson’s biplane method. Collect the left ventricular apical long axis, four andtwo chamber views, and short axis views of the basal level, the papillary muscle level. Tomeasure each group segments of systolic peak of longitudinal strain(LS), circumferentialstrain(CS), radial strain (RS). Then to analysis them using Qlab6.0TMQA.Results:（1）Compare group A with group N，LAD、LVIDd、LVEDV、LVESV、SV increaseobviously(p<0.05）; Compare group B、group C with group A，LAD、LVIDd、LVEDV、LVESV decrease obviously﹙p<0.05）；Compare group C with group N，there are nosignificant differences；(2) Compare group A with group N in different segments, the peakvalue of longitudinal strain obviously decrease, there are statistics meanings indifferences(p<0.05); Compare group B with group A, the change of each segments peaklongitudinal strain are not obvious; Group C is close to group N, there are no significantdifferences（P>0.05）;(3) The systolic peak circumferential strain of the short axis papillarymuscle level are maximum, the basal level is minimum. Compare group A with group N,both of them the systolic peak circumferential strain are decreased obviously（P<0.01）;Compare group B、group C with group A，the change of the basal level systolic peakcircumferential strain are not obviou（sP>0.05）; and which are lower than group N（P<0.05）;Compare group B、group C with group A，the change of the papillary muscle level systolic peak circumferential strain are obvious increase（P<0.05）; Compare group C with group N,there are no significant differences（P>0.05）;(4) Each myocardial segments of leftventricular short axis radial strain curves are positive curves. Compare group A with group N,both of the short axis radial strain peak value are obviously decrease（P<0.05）. Compare thebasal level group B with group A, the peak of radial strain are no change（P>0.05）; Comparethe papillary muscle level of group B﹑group C with group A, the peak value of the radialstrain increases(P<0.05); Group C is close to group N, there are no significant differences（P>0.05）.Conclusions: Speckle tracking imaging can find the regional myocardial systolicdysfunction before the change of left ventricular ejection fraction. And it can evaluate thechange of left ventricular function after the mitral valvuloplasty.