The Influences Of Annuloplasty Procedures In Mitral Repair On Left Ventricular Vortex Flow Pattern
Hiroko Morichi1, Keiichi Itatani1, Satoshi Numata1, Sachiko Yamazaki1, Satoshi Taniguchi1, Tomohito Kanzaki1, Kaichiro Manabe1, Koki Ikemoto1, Haruka Fu1, Kosuke Nakaji2, Nagara Tamaki2, Kei Yamada2, Shohei Miyazaki3, Teruyasu Nishino3, Hitoshi Yaku1.
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan, 3Cardio Flow Design Inc., Tokyo, Japan.
Background: Several types of annuloplasty rings and bands have been used in mitral valve repair (MVP) with different concepts, but their actual effects on left ventricular hemodynamics especially on mitral inflow and aortic outflow has not been fully revealed. We performed vortex flow evaluation with 4D flow MRI in patients after MVP. Methods: Twenty-one normal controls, seven patients with CG future band (CG), five with Physio II ring (PHY), and one with Tailor band (TA) with different sizes were examined in 4D flow MRI. Influences of annuloplasty procedure types on diastolic intraventricular vortex flow patterns, and systolic aortic outflow patterns were examined in addition to flow energy loss (EL) in 1 cardiac cycle. Results: The band sizes of CG were 28 mm in 1 patient, 30 mm in 1, 32 mm in 1, 34 mm in 2, 36 mm in 2, and the ring sizes of PHY used were 28 mm in 1 patient, 30 mm in 1, 32 mm in 1, 34 mm in 1, 36 mm in 2, and the ring size of TA used was 33 mm. Diastolic intraventricular flow after MVP made larger vortices beneath anterior and posterior leaflets compared with those in normal controls. Anterior vortices after MVP were consisted of two-strands. Relationship between EL and the transmitral mean pressure gradient during diastole was significant (r=0.63, p=0.04). In systole, some patients with smaller rings or bands compared with patient's body size had disturbed outflow due to vortex flow inside LV, resulting in high EL. PHY restricted aortic annulus systolic motion, and then it caused slight EL elevation with EL distribution pattern changed. Conclusions: MAP patients had larger left ventricular vortex in diastole regardless of the repair type than healthy volunteer. In systole, small size annular ring or band caused narrowed LV outflow pattern. The effect of vortex flow pattern change on long-term ventricular function after the MVP is to be studied.
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