The Influence Of Left Ventricular Myocardium Of Rheumatic Mitral Stenosis By Mitral Valve Replacement With Preservation Of Subvalvular Apparatus

Objective To detect parameters of left ventricular sarcomere segment, to evaluate left ventricular structure of rheumatic mitral stenosis(RMS)patients before operation; To evaluate the influence of left ventricular myocardium of rheumatic mitral stenosis after mitral valve replacement with preservation of subvalvular apparatus(MVRP).Methods 25 Rheumatic mitral stenosis patients(group A),who were diagnosised by clinical examination, real-time three-dimensional echocardiography(RT-3ED)and postoperative pathologic in Fujian Province Hospital from October in 2014 to December 2014 year,were selected. 20 healthy individuals were enrolled as control group.25 cases of patients with RMS undergoed mitral valve replacement operation with preservation of subvalvular apparatus. The 25 patients after operation were classfied into group B. The data and image of two dimensional echocardiography and real-time three-dimensional echocardiography were collected by GE Vivid E9 Doppler ultrasonic diagnostic apparatus. The age of patients, blood pressure before and after the operation, valve area, aortic cross clamping time, amount of bleeding, the overall cycle time in operation were recorded. Three groups were examed by two-dimensional echocardiography(2DE) and RT-3 DE, and we gathered the values of left ventricular ejection fraction(LVEF)、left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV)、left ventricular end systolic volume(LVESV)by 2 DE, and also gathered the value of LVEF、LVEDV 、LVESV、the longitudinal strain, circumferential strain, area strain, lateral strain of left ventricular myocardial each segment by RT-3DE, before and after operation. Each data was tested by Shapiro-Wilk inspection. The groups of heart function and synchrony parameters were compared by two independent samples t test, if they were normal distribution. the difference was statistically significant(P < 0.05). The parameters of heart function and synchronization were compared by paired samples t test, the difference was statistically significant(P < 0.05).If it was not the normal distribution, the Wilcoxon rank sum test was used, the difference was statistically significant(P < 0.05). Resule The LVEF of 2DE was no difference between three groups. The LVEF、LVEDV、LVESV were significantly difference between experience group and control group. A group of left ventricular myocardial longitudinal strain was significantly different from the control group, The circumferential strain, area strain, lateral strain in group A had no significant difference from control group. middle segment wall strain of left ventricular myocardial segment was significantly difference between A group and B group.Conclusion 1、To detect the motion parameters in the patients of RMS with left ventricular myocardial segments by RT-3DE, it is proved that there were changed of left ventricular structure in the patients of RMS. 2、After operation, The motion amplitude of post papillary muscles what attached to left ventricular wall was bigger than other. 3、The MVRP should keep the integrity of the left ventricular structure, prevent excessive expansion of the left ventricle, reduce the risk of complications after valve replacement.