Relation Of Pathologic Changes To Myocardial Motion In Rheumatic Mitral Stenosis

AIM Evaluating the relation of pathologic changes to myocardial motion in rheumatic mitral stenosis(MS) to search the non-invasive methods to predict the cardiac function of rheumatic mitral stenosis patients after replacement of mitral valve.METHODS 22 patients (16 women and 6 men, aged 43. 3 ?10.1 years)with MS, except coronary heart disease, congenital heart disease, hypertension and dilated congestive cardiomyopathy , who hospitalizated in the department of cardiac surgery of Xijing Hospital from May 2003 to October 2003 underwent echocardiography examination including Doppler tissue imaging(DTI) by the same docter 2 to 5 days before replacement of mitral valve. The area of mitral valve, left ventricularejection fraction(EF) and left ventricular fraction shortening (FS) were measured. And the DTI program was applied in the pulse wave mode, DTI spectra of interventricular septum mitral annulus in the long axis were recorded. Tracing electrocardiograph at the same time, and storeing ten cycles of spectra. Measuring the velocity of S peak and D pesk in the long axis of mitral annulus, and pre-ejection period (PEP, the time interval from the onset of QRS to the onset of systolic wave). Calculating the means of ten cardiac cycles as Si10 D10 T10 and the means of three cardiac cycles with biggist peaks as S3 D3 T3. Specimens of papillary muscles were analyzed which were obtained at the time of mitral valve replacement. The specimens were put into 40g/L formaldehydum polymerisatum immediately, and then embedded in paraffin and cut into 3 urn sections, they were stained with hematoxylin-eosin and Masson stain. Measuring the diameter of myocardial cell, the ratio of inside to outside of myocardium arteriole (Di/Do) , percent interstitial fibrosis of myocardium, and endocardium thick(ET). According the rules of Professor Zhang Baoren, the paitents fit to two of the four teams as follow divided into the group of serious myocardial pathologic changes, the others divided into the group of minimal myocardial pathologic changes. (1) percent interstitial fibrosis>31%; (2) Di/Do<0.40; (3)ET>326um;(4) diameter of myocardial cell>16um. According the postoperative recovery, ICU time and theapplication time of special drugs, the patients who were died, stayed in ICU over three days and applicated the special drugs over two weeks were divided into poor prognosi group and the others divided into fine prognosi group.RESULTS It is indicated by correlation analysis and linear regression, that arteriole Di/Do has positive correlation with D3, r = 0.50(P<0.05), D3=0. 019+0. 167Di/Do; percent interstitial fibrosis has positive correlation with T3, r=0.68 (P<0.05), T3 = 0. 049+0. 0026(percent interstitial fibrosis); likewise a positive correlation was present between S3 and D3, r=0.43 (P<0. 05). S3 T3 D3 have significantly difference between fine prognosi group and poor prognosi group. S3 and D3 are faster in fine prognosi group than that in poor prognosi group, and T3 is shorter in fine prognosi group than that in poor prognosi group. Age, weight, the area of valve, EF and FS have no significantly difference between two groups. T3 is shorter in the group of minimal myocardial pathologic changes than that in the group of serious myocardial pathologic changes. Age, weight, the area of valve, EF, FS, S3 and D3 have no significantly difference between two groups.CONCLUSION Measuring S3 T3 and D3 by DTI before operation, could reflect pathologic changes of myocardium. It is helpful for controlling the opportunity of operation and predicting theprognosis.