Transesophageal echocardiography evaluates the residual mitral regurgitation and its influencing factors in patients with HOCM after myocardial resection
Objective:To evaluate the residual mitral regurgitation(MR)and its influencing factors in patients with hypertrophic obstructive cardiomyopathy(HOCM)after transapical Beating-Heart Septal Myectomy(TA-BSM),and to follow up the postoperative outcome,so as to provide an objective basis for clinical management de-cisions.Methods:A total of 155 patients diagnosed with HOCM and receiving TA-BSM in our hospital from May 2023 to December 2023 were prospectively enrolled.Transesophageal echocardiography(TEE)was used for real-time monitoring and navigation throughout the operation.1)The maximum ventricular septal thickness,left ven-tricular outflow tract peak pressure difference(LVOT-PG),SAM grade and MR Degree were evaluated.2)The two-dimensional structural characteristics of the mitral valve(MV)were measured,including the length of the an-terior and posterior leaflets,the length of the residual leaflets,and the involutional height of the anterior and pos-terior leaflets.3)Three-dimensional(3D)MV volume images were obtained,and Tomtec workstation was used to analyze the valve leaf area,tent height,tent area,tent volume,and inner diameter,perimeter,area and height of the valve ring.According to whether there was MR≥2+immediately after myectomy,the patients were divided into residual group and non-residual group,and the differences of MV structural parameters between the two groups were compared.Univariate and multivariate binary logistic regression were used to explore the structural characteristics of MV that affected residual MR After myocardial resection.Transthoracic echocardiography(TTE)was used to follow up obstruction and MR Improvement 3 months after operation.Results:During TA-BSM,the wall thickness of the basal and middle segments of the anterior and posterior ventricular septum was significantly decreased(all P＜0.01),and the LVOT-PG was significantly decreased(P＜0.01).The number of patients with MR≥3+immediately after surgery decreased from 111 cases(71.6％)to 9 cases(5.8％)(all P＜0.01).There were 39 patients(25.2％)in residual group and 116 patients(74.8％)in non-residual group with MR≥2+immediately after operation.Univariate analysis and multivariate binary Logistic regression analysis showed that age,MV calcification,MV thickening ≥5 mm and MV ring height＜10.0 mm were independent in-fluencing factors of postoperative residual MR Reflux(all P＜0.05).At the follow-up of 3 months after opera-tion,51％of the residual group had MR Degree improved to less than 2+(P＜0.01).Conclusion:Age,MV cal-cification or thickening,and annulus height are the main factors affecting the immediate postoperative residual MR≥2+.The 51％of intraoperative residual reflux can be improved during follow-up,and intraoperative surgical treatment is not required.
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