Experiment Research of Mitral Valve Coaptation Area and Coaptation Index China_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jiyong , HE Yihua , ZHANG Jianqun , WANG Linlin , ZHANG Liang.

1. Department of Cardiac Surgery，Beijing Institute of Heart Lung and Blood Vessel Disease，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，P.R.China;;
2. Department of Echocardiography，Beijing Institute of Heart Lung and Blood Vessel Disease，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，P. R. China;;
3. Department of Anesthesia，Beijing Institute of Heart Lung and Blood Vessel Disease，;

Corresponding author：

Keywords：

Coaptation index; Coaptation area; Mitral valve regurgitation

DOI：

10.7507/1007-4848.20130135

Video：

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Objective To investigate the changing tendency of mitral valve coaptation area and coaptation index of moderate mitral regurgitation （MR） in a dog experiment，and provide evidence for predicting long-term surgical results. Methods Real-time three-dimensional transesophogeal echocardiography （RT-3D-TEE） images were obtained in 15 dogs via Philips IE33 echocardiography system，and animal experiment model was established. RT-3D-TEE images were taken by gradually narrowing the ascending aorta and increasing left ventricular pressure till moderate MR. Original data were analyzed using Philips Qlab 7.0 three-dimensional quantification software，and mitral valve coaptation area and coaptation index were calculated. Specimen coaptation index of the mitral leaflets was calculated after the animal experiment. Cutoff values of coaptation index and left ventricular pressure were calculated by receiver operating characteristic （ROC） curve. Results There was statistical difference in coaptation area （198±50）mm2 vs. （123±36）mm2，P＜0.05） and coaptationindex （0.25±0.06 vs. 0.13±0.03，P＜0.05） between non-MR state and MR status of the 15 dogs. The area under the ROC curve of coaptation index and moderate MR was 0.879±0.019 with 95% CI 0.843 to 0.916，and the cutoff value was 0.213（P＜0.05）. The area under the ROC curve of left ventricular pressure and moderate MR was 0.882±0.021 swith 95% CI 0.840 to 0.923，and the cutoff value was 225 （P＜0.05）. There was no statistical difference between specimen mitral valve area and early-diastolic mitral leaflet area，specimen coaptation area and coaptation area，specimen coaptation index and coaptation index （P＞0.05）. Early-diastolic mitral leaflet area was significantly correlated with specimen mitral valve area （r=0.937，P＜0.05）. Coaptation area was significantly correlated with specimen coaptation area （r=0.917，P＜0.05）. Coaptation index was significantly correlated with specimen coaptation index （r=0.946，P＜0.05）. The correlation of coaptation index and specimen coaptation index was higher than those of coaptation area and specimen coaptation area，and earlydiastolic mitral leaflet area and specimen mitral valve area. Conclusions Both coaptation area and coaptation index significantly decrease in MR status. Coaptation index can more precisely reflect MR degree，and provide reference for prognosis of mitral valve repair. RT-3D TEE can accurately measure mitral valve coaptation area and coaptation index.

Citation： LI Jiyong,HE Yihua,ZHANG Jianqun,WANG Linlin,ZHANG Liang.. Experiment Research of Mitral Valve Coaptation Area and Coaptation Index China. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 446-450. doi: 10.7507/1007-4848.20130135 Copy

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3.	韩建成，李治安，何怡华，等. 经食管实时三维超声心动图检测二尖瓣对合指数的临床应用研究. 中华医学超声杂志：电子版， 2010， 7 （8）：1295-1301.
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7.	Sfeir PM， Jebara VA， Ayoub CM. Mitral valve repair or replacementin elderly people. Curr Opin in Anaesthesiol， 2006， 19 （1）：82-87.
8.	Ryan LP， Salgo IS， Gorman RC. Gorman JH 3rd. The emerging role of three-dimensional echocardiography in mitral valve repair.Semin Thorac Cardiovasc Surg， 2006， 18 （2）：126-134.
9.	Bortolotti U， Celiento M， Pratali S， et al. Recurrent mitral regurgitation due to ruptured artificial chordae：case report and review of the literature. J Heart Valve Dis， 2012， 21 （4）：440-443.
10.	De Bonis M， Lapenna E， Lorusso R， et al. Very long-term results （up to 17 years） with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation. J Thorac Cardiovasc Surg， 2012， 144 （5）：1019-1024.
11.	Quill JL， Hill AJ， Laske TG， et al. Mitral leaflet anatomy revisited. J Thorac Cardiovasc Surg， 2009， 137 （5）：1077-1081.
12.	Levack MM， Jassar AS， Shang EK， et al. Three-dimensional echocar-diographic analysis of mitral annular dynamics：implication for annuloplasty selection. Circulation， 2012， 126 （11 Suppl 1）：S183-S188.
13.	Grewal J， Mankad S， Freeman WK， et al. Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease. J Am Soc Echocardiogr， 2009， 22 （1）：34-41.
14.	Jungwirth B， Mackensen GB. Real-time 3-dimensional echocardiography in the operating room. Semin Cardiothorac Vasc Anesth， 2008， 12 （4）：248-264.
15.	Saito K， Okura H， Watanabe N， et al. Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functionalmitral regurgitation. JACC Cardiovasc Imaging， 2012， 5 （4）：337-345.
16.	Choi JB， Kim KH， Kim MH， et al. Improvement of mitral valve coaptation with supraannular plication of the posterior annulus——anewly designed strip for posterior annular plication. Ann ThoracCardiovasc Surg， 2012， 18 （2）：95-100.
17.	Ajayi OE， Abiona TC， Balogun MO， et al. Valvular regurgitation impact on left ventricular 2-dimensional and Doppler echocardiographic indices in patients with essential hypertension. J Natl Med Assoc， 2010， 102 （10）：937-942.

1. 　Bortolotti U， Milano AD， Frater RW. Mitral valve repair withartificial chordae：a review of its history， technical details， long-term results， and pathology. Ann Thorac Surg， 2012， 93 （2）：684-691.
2. 　潘泽雁，何怡华，李治安，等. 超声测量二尖瓣对合高度对二尖瓣脱垂成形效果的评价. 心肺血管病杂志， 2012， 31 （6）：690-693.
3. 　韩建成，李治安，何怡华，等. 经食管实时三维超声心动图检测二尖瓣对合指数的临床应用研究. 中华医学超声杂志：电子版， 2010， 7 （8）：1295-1301.
4. 　Ranganathan N， Lam JH， Wigle ED， et al. Morphology of thehuman mitral valve.Ⅱ . The value leaflets. Circulation， 1970， 41 （3）：459-467.
5. 　孟旭，主编. 现代成人心脏外科二尖瓣修复理念. 北京：北京出版社， 2005. 69.
6. 　李继勇，张健群，张富恩，等. 后叶腱索转移治疗二尖瓣前叶脱垂. 中国胸心血管外科临床杂志， 2009， 16 （3）：170-173.
7. 　Sfeir PM， Jebara VA， Ayoub CM. Mitral valve repair or replacementin elderly people. Curr Opin in Anaesthesiol， 2006， 19 （1）：82-87.
8. 　Ryan LP， Salgo IS， Gorman RC. Gorman JH 3rd. The emerging role of three-dimensional echocardiography in mitral valve repair.Semin Thorac Cardiovasc Surg， 2006， 18 （2）：126-134.
9. 　Bortolotti U， Celiento M， Pratali S， et al. Recurrent mitral regurgitation due to ruptured artificial chordae：case report and review of the literature. J Heart Valve Dis， 2012， 21 （4）：440-443.
10. 　De Bonis M， Lapenna E， Lorusso R， et al. Very long-term results （up to 17 years） with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation. J Thorac Cardiovasc Surg， 2012， 144 （5）：1019-1024.
11. 　Quill JL， Hill AJ， Laske TG， et al. Mitral leaflet anatomy revisited. J Thorac Cardiovasc Surg， 2009， 137 （5）：1077-1081.
12. 　Levack MM， Jassar AS， Shang EK， et al. Three-dimensional echocar-diographic analysis of mitral annular dynamics：implication for annuloplasty selection. Circulation， 2012， 126 （11 Suppl 1）：S183-S188.
13. 　Grewal J， Mankad S， Freeman WK， et al. Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease. J Am Soc Echocardiogr， 2009， 22 （1）：34-41.
14. 　Jungwirth B， Mackensen GB. Real-time 3-dimensional echocardiography in the operating room. Semin Cardiothorac Vasc Anesth， 2008， 12 （4）：248-264.
15. 　Saito K， Okura H， Watanabe N， et al. Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functionalmitral regurgitation. JACC Cardiovasc Imaging， 2012， 5 （4）：337-345.
16. 　Choi JB， Kim KH， Kim MH， et al. Improvement of mitral valve coaptation with supraannular plication of the posterior annulus——anewly designed strip for posterior annular plication. Ann ThoracCardiovasc Surg， 2012， 18 （2）：95-100.
17. 　Ajayi OE， Abiona TC， Balogun MO， et al. Valvular regurgitation impact on left ventricular 2-dimensional and Doppler echocardiographic indices in patients with essential hypertension. J Natl Med Assoc， 2010， 102 （10）：937-942.

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