Energy dynamics of the intraventricular vortex after mitral valve surgery

被引:33
作者
Nakashima, Kouki [1 ,2 ,3 ]
Itatani, Keiichi [4 ]
Kitamura, Tadashi [3 ]
Oka, Norihiko [3 ]
Horai, Tetsuya [3 ]
Miyazaki, Shohei [2 ]
Nie, Masaki [1 ,3 ]
Miyaji, Kagami [2 ,3 ]
机构
[1] Ebina Gen Hosp, Dept Cardiovasc Surg, 1320 Kawaraguchi, Ebina, Kanagawa 2431311, Japan
[2] Kitasato Univ, Sch Med, Dept Hemodynam Anal, Minami Ku, 1-15-1 Kitasato, Sagamihara, Kanagawa 2520375, Japan
[3] Kitasato Univ, Dept Cardiovasc Surg, Sch Med, Minami Ku, 1-15-1 Kitasato, Sagamihara, Kanagawa 2520375, Japan
[4] Kyoto Prefectual Univ Med, Dept Cardiovasc Surg, Kamigyo Ku, 465 Kajii Cho, Kyoto 6020841, Japan
关键词
Vector flow mapping (VFM); Mitral valve surgery; Flow energy loss; LEFT-VENTRICLE; BLOOD-FLOW;
D O I
10.1007/s00380-017-0967-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Mitral valve morphology after mitral valve surgery affects postoperative intraventricular flow patterns and long-term cardiac performance. We visualized ventricular flow by echocardiography vector flow mapping (VFM) to reveal the impact of different mitral valve procedures. Eleven cases of mechanical mitral valve replacement (nine in the anti-anatomical and two in the anatomical position), three bioprosthetic mitral valve replacements, and four mitral valve repairs were evaluated. The mean age at the procedure was 57.4 +/- 17.8 year, and the echocardiography VFM in the apical long-axis view was performed 119.9 +/- 126.7 months later. Flow energy loss (EL), kinetic pressure (KP), and the flow energy efficiency ratio (EL/KP) were measured. The cases with MVR in the anatomical position and with valve repair had normal vortex directionality ("Clockwise"; N = 6), whereas those with MVR in the anti-anatomical position and with a bioprosthetic mitral valve had the vortex in the opposite direction ("Counterclockwise"; N = 12). During diastole, vortex direction had no effect on EL ("Clockwise": 0.080 +/- 0.025 W/m; "Counterclockwise": 0.083 +/- 0.048 W/m; P = 0.31) or KP ("Clockwise": 0.117 +/- 0.021 N; "Counterclockwise": 0.099 +/- 0.057 N; P = 0.023). However, during systole, the EL/KP ratio was significantly higher in the "Counterclockwise" vortex than that in the "Clockwise" vortex (1.056 +/- 0.463 vs. 0.617 +/- 0.158; P = 0.009). MVP and MVR with a mechanical valve in the anatomical position preserve the physiological vortex, whereas MVR with a mechanical valve in the anti-anatomical position and a bioprosthetic mitral valve generate inefficient vortex flow patterns, resulting in a potential increase in excessive cardiac workload.
引用
收藏
页码:1123 / 1129
页数:7
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