Transesophageal echocardiography assessment of mitral valve for patients with atrial septal defects undergoing surgical repair.

Abstract

Objectives: To investigate the application of transesophageal echocar-diography assessment for mitral valve in patients with atrial septal defects undergoing repair surgery.

Methods: Thirty-two adult patients with atrial septal defect underwent thoracoscopic repair surgery at the First Affiliated Hospital of Military Medical University of the PLA Air Force from March to September 2022 were collected (study group). The two-dimensional and real-time three-dimensional transesophageal ultrasonography of the mitral valve were performed after anesthesia. The parameters of the mitral valve structure in the late diastolic and late systolic stages were recorded, including anteroposterior and left-right annular diameters, anterior and posterior valves lengths, the vertical distance from the coaptation point of leaflet zone 2 during systole to the annular plane (mitral valve coaptation depth) and mitral valve coaptation length. The above data of 32 patients with normal intracardiac structure and no mitral valve regurgitation (control group) were also collected and compared with those of the study group. The concurrent mitral valvoplasty was performed during the atrial septal defect repair surgery for 7 patients with significant mitral valve structural abnormalities and 2 patients with significantly increased mitral regurgitation after cardiac resuscitation. The study group was followed up with transthoracic echocardiography for 2 years postoperatively.

Results: In the study group, 26 (81.3%) patients had different degrees of mitral valve morphological abnormalities, of whom 10 patients (31.3%) had short mitral valve coaptation length or coaptation depth, 12 (37.5%) patients had a closure point malposition, and 4 (12.5%) patients had different bulge of anterior and posterior leaflets. Compared with the control group, in the study group the systolic and diastolic mitral left-right annular diameter, mitral posterior valves lengths, mitral coaptation length or coaptation depth were significantly smaller (all P<0.05), the lung/body circulation blood flow ratio was higher (P<0.05), and the maximum blood flow velocity across the mitral valve was lower (P<0.01). After 2 years of follow-up, in 9 patients who underwent concurrent mitral valvoplasty the mitral valve maintained no or little regurgitation, and the average mitral valve pressure difference was less than 5 mmHg (1 mmHg=0.133 kPa); in 23 patients without concurrent mitral valvoplasty, 2 patients had moderate regurgitation 1 year after surgery, with a pulmonary/systemic flow ratio larger than 2.8.

Conclusions: Patients with large atrial septal defects are often complicated with abnormal mitral valve structure, so transesophageal echocardiography is recommended for mitral valve assessment during the surgery, if patients have significant mitral valve structural abnormalities the concurrent mitral valvoplasty can be performed.