| Objective: The transthoracic echocardiography and intraoperative transesophageal echocardiography(TEE)were used in the diagnosis of isolated mitral valve cleft,in regarding to clinical decision-making,the choice of surgical procedure,and assessment of valve and cardiac function.Methods: The surgical procedure and echocardiographic imaging database of mitral valve cleft were analyzed retrospectively from January 2010 to September 2017.The exclusion criterion: Clinical data and echocardiography before and after operation were collected.Grouping by age 15: adults and children younger than 15.According to the extent of the involvement of lobectomy lesions,the extent of the involvement of lobectomy was limited to group I,group II,and group III.According to the location of mitral anterior division: A1,A2,A3,A1A2 and A2A3.According to the severity of mitral regurgitation.To explore the age distribution and characteristics of isolated mitral valve cleft.Statistical analysis of preoperative degree of mitral regurgitation postoperatively,and the size of the left atrium,left ventricle and left heart function changes,and the crack degree and severity of mitral regurgitation do correlation analysis and the choice of operative methods.The cardiac data were analyzed using SPSS17.0 software,and cardiac image acquisition and data measuring were according to the guidelines of the American Society of Echocardiography.Results: 1.81 patients were enrolled(43 males and 38 females,the age range from 1 to 75-year-old,the median age was 11-year-old),and a total of 426 echocardiographic reports were collected.Among them,43(53.09%)patients under 15-year-old were grouped as children group;38(46.91%)patients were adult.The age distribution map shows that children group 0-10 years old and adults group 40-50 years old are compared with other ages in the same group,and the number of patients is relatively high.2.The degree of mitral regurgitation statistics: preoperative MR0 level 0 case,MR1 0 case,MR2 11 cases(7 cases in children’s group,Adult group 4 cases),MR3 level 32 cases(17 cases in children’s group,Adult group 15 cases),MR4 level 34 cases(19 cases in children’s group,Adult group 15 cases),MR5 level 4 cases(0 case in children’s group,Adult group 4 cases).Follow-up results at 3 months after surgery were as follows: there were 42 cases of MR0(22 cases in the children’s group and 20 cases in the adult group),48 cases of MR1(21 cases in the children’s group and 18 cases in the adult group),and 0 case of MR2 or above.The difference before and after surgery was statistically significant(P < 0.05)by rank sum test.3.The pre-procedure and post-procedure data were analyzed,including the left atrium,left ventricle,left heart function.The follow-up time of the data was more than 3 months,for early postoperative data were influenced by drug and capacity interference.The paired sample T test was applied.The left atrium diameter(LAAP)and left ventricular end-diastolic diameter(LVEDD)decrease dramatically post-procedure,which showed the significant difference(P < 0.05);In children group,left ventricular function(left ventricular ejection fraction(LVEF))showed no significant difference at 3-month follow-up(The reason may be that the time of children’s examination and surgical procedure were in time as the heart failure is less developed);The pre-procedure LVEF in the adult group showed significant difference compared with the preoperative(P < 0.05).4.Characteristics of mitral valve cleft width and location distribution: in 81 cases of mitral valve cleft,the distribution range of mitral valve cleft width(mm)was 2-15,median 5,mean±standard deviation: 5.938±2.856.According to the statistics of the location of mitral valve cleft,80 cases(98.76%)and 1 case(1.23%)of the anterior mitral valve cleft were observed.The location distribution characteristics of the anterior mitral valve cleft in 80 cases :(1)66 cases located in mitral commissure(anterolateral commissure,A1 were 32(40.00%),posteromedial commissure,A3 were 34(42.50%)),the anterior mitral valve position(A2)were 10(12.50%).At the junction of A1A2 or A2A3,there were 2(2.50%)respectively(Figure 4).The anterolateral and posteromedial commissure,A1 and A3 of mitral valve had the high incidence.5.There were 20 patients with mitral cleft I °.The MR grade 2,3,4,and 5 levels were 4(20.00%),6(30.00%),7(35.00%),3(15.00%)respectively.Among 38 patients with mitral valve cleft II°,there were 1(2.63%),10(26.32%),8(21.05%),and 19(50.00%)corresponding to MR grade 2,3,4 and 5.There were 23 cases with mitral cleft III°,and the of MR grade 2,MR grade 3,MR grade 4 and 5 were 0(0.00%),2(8.70%),8(34.78)and 13 cases(56.52%)respectively.Mitral valve cleft between dividing and MR grading Spearman correlation coefficient is 0.36968,inspection P values 0.0007(P < 0.05),There was statistical significance between the two groups,and there was a linear correlation,but the correlation was not strong,which was a general correlation.It indicates that the degree of MR severity of mitral valve cleft increases from I degree to III degree.6.Statistical results of operation patterns(MVP and MVR): 41 cases of MVP in children group(95.35%),24 cases of MVP in adult group(63.16%),15 cases(75.00% in grade I group)of fracture row MVP 31 cases(81.58% in grade II group)and 19 cases(82.61% in grade III group)were split row MVP 31 cases.All the above shows that the proportion of MVP is high in level I-III groups,adult group and children group.7.Spearman correlation coefficient/test P values between the level of mitral cleft and the operation(MVR,MVP),MR grading and the operation(MVR,MVP)were-0.0.067/0.5508 and 0.1008/0.3707 respectively.The level of mitral valvular fissure was negatively correlated with the operation,but the correlation was weak.There was a positive correlation between MR classification and operation,and the correlation was weak(P >0.05).Probably because the sample size was too small,which did not indicate that the difference was statistically significant.In conclusion,with the increase of the level of mitral cleft,the severity of MR presented a development trend,and the difficulty of MVP surgery increased accordingly.Since the autogenous valve is retained by MVP surgery,it is very important for the late growth and development,especially for children,and obviously beneficial to patients.However,artificial mechanical valve requires lifelong anticoagulation,and there are complications such as bleeding or thrombus and artificial valve dysfunction.In addition,biological valve has a time limit,and the patient is prone to artificial valve damage due to infection.It indicates that the degree of MR severity of mitral valve cleft increases from I degree to III degree.For the retaining anatomy of mitral valve in MVP,late growth especially children is very important,and artificial mechanical valve need lifelong waring anticoagulant drugs,however,bleeding complications occurs sometimes.Conclusions: 1.The A1 and A3 areas of mitral valve are the high-prevalence area of isolated mitral cleft.As the grade of mitral fissure(I-III)increases,the severity of MR(0-5)presents a developing trend,and the difficulty of mitral valve surgical MVP also increases.In this study,the proportion of MVP in the adult group,the children group and the mitral cleft was high,Since MVP retains the patient’s autologous valve,compared with MVR patients,no lifelong anticoagulation is required after surgery,and complications of postoperative hemorrhage or thrombosis are avoided.MVP is obviously beneficial to patients.Therefore,accurate evaluation of isolated mitral valve cleft by transthoracic echocardiography and transesophageal echocardiography is helpful to surgical procedure decision-making.2.Transthoracic echocardiography plays an important role in the follow-up of evaluating valve function,clarifying the structural remodeling and the left ventricular function. |
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