- 著者
- Nobuyuki Kagiyama Misako Toki Akihiro Hayashida Minako Ohara Atsushi Hirohata Keizo Yamamoto Toshinori Totsugawa Taichi Sakaguchi Kiyoshi Yoshida Mitsuaki Isobe
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.81, no.11, pp.1730-1735, 2017-10-25 (Released:2017-10-25)
- 参考文献数
- 26
- 被引用文献数
- 6 8
Background:As mitral valve (MV) repair for Barlow’s disease remains surgically challenging, it is important to distinguish Barlow’s disease from fibroelastic deficiency (FED) preoperatively. We hypothesized that the prolapse volume to prolapse height ratio (PV-PH ratio) may be useful to differentiate Barlow’s disease and FED.Methods and Results:In 76 patients with MV prolapse who underwent presurgical transesophageal echocardiography, the 3D MV morphology was quantified: 19 patients were diagnosed with Barlow’s disease and 57 with FED. The patients with Barlow’s disease had greater prolapse volume and height than the patients with FED, as well as greater PV-PH ratio (0.61±0.35 vs. 0.17±0.10, P<0.001). Receiver-operating characteristic analysis revealed that with a cutoff value of 0.27, the PV-PH ratio differentiated Barlow’s disease from FED with 84.2% sensitivity and 84.2% specificity. Net reclassification improvement showed that the differentiating ability of the PV-PH ratio was significantly superior to prolapse volume (1.30, P<0.001). After being adjusted by each of prolapse volume and height, annular area and shape, and the number of prolapsed segments, the PV-PH ratio had an independent association with Barlow’s disease.Conclusions:The PV-PH ratio was able to differentiate Barlow’s disease from FED with high accuracy. 3D quantification including this value should be performed before MV repair.
- 著者
- Hidetoshi Yoshitani Akihiro Isotani Jae-Kwan Song Shinichi Shirai Hiromi Umeda Jeong Yoon Jang Takeshi Onoue Misako Toki Byung-Joo Sun Dae-Hee Kim Nobuyuki Kagiyama Akihiro Hayashida Jong-Min Song Masataka Eto Yosuke Nishimura Kenji Ando Michiya Hanyu Kiyoshi Yoshida Robert A. Levine Yutaka Otsuji
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-18-0390, (Released:2018-08-22)
- 参考文献数
- 24
- 被引用文献数
- 3
Background: Basal interventricular septum (IVS) hypertrophy (BSH) with reduced basal IVS contraction and IVS-aorta angle is frequently associated with aortic stenosis (AS). BSH shape suggests compression by the longitudinally elongated ascending aorta, causing basal IVS thickening and contractile dysfunction, further suggesting the possibility of aortic wall shortening to improve the BSH. Surgical aortic valve replacement (SAVR), as opposed to transcatheter AVR (TAVR), includes aortic wall shortening by incision and stitching on the wall and may potentially improve BSH. We hypothesized that BSH configuration and its contraction improves after SAVR in patients with AS. Methods and Results: In 32 patients with SAVR and 36 with TAVR for AS, regional wall thickness and systolic contraction (longitudinal strain) of 18 left ventricular (LV) segments, and IVS-aorta angle were measured on echocardiography. After SAVR, basal IVS/average LV wall thickness ratio, basal IVS strain, and IVS-aorta angle significantly improved (1.11±0.24 to 1.06±0.17; −6.2±5.7 to −9.1±5.2%; 115±22 to 123±14°, P<0.001, respectively). Contractile improvement in basal IVS was correlated with pre-SAVR BSH (basal IVS/average LV wall thickness ratio or IVS-aorta angle: r=0.47 and 0.49, P<0.01, respectively). In contrast, BSH indices did not improve after TAVR. Conclusions: In patients with AS, SAVR as opposed to TAVR improves associated BSH and its functional impairment.