PDF(Pubmed)
Abstract：
UNASSIGNED: Congenital mitral valve disease (CMVD) presents major challenges in its medical and surgical management.
UNASSIGNED: The purpose of this study was to investigate the value of 3-dimensional echocardiography (3DE) and identify associations with MV reoperation in this setting.
UNASSIGNED: All children <18 years of age who underwent MV reconstruction for CMVD in 2002 to 2018 were included. Preoperative and postoperative 2-dimensional echocardiography (2DE) and 3DE data were collected. Competing risks and Cox regression analysis were used to identify independent associations with MV reoperation. Receiver operating characteristic and decision-tree analysis were implemented for comparison of 3DE vs 2DE.
UNASSIGNED: A total of 206 children underwent MV reconstruction for CMVD (mitral stenosis, n = 105, mitral regurgitation [MR], n = 75; mixed disease, n = 26); 64 (31%) required MV reoperation. Variables independently associated with MV reoperation were age <1 year (HR: 2.65; 95% CI: 1.13-6.21), tethered leaflets (HR: 2.00; 95% CI: 1.05-3.82), ≥ moderate 2DE postoperative MR (HR: 4.26; 95% CI: 2.45-7.40), changes in 3D-effective orifice area (3D-EOA) and in 3D-vena contracta regurgitant area (3D-VCRA). Changes in 3D-EOA and 3D-VCRA were more strongly associated with MV reoperation than changes in mean gradients (area under the curve [AUC]: 0.847 vs AUC: 0.676, P = 0.006) and 2D-VCRA (AUC: 0.969 vs AUC: 0.720, P = 0.012), respectively. Decision-tree analysis found that a <30% increase in 3D-EOA had 80% accuracy (HR = 8.50; 95% CI: 2.9-25.1) and a <40% decrease in 3D-VCRA had 93% accuracy (HR: 22.50; 95% CI: 2.9-175) in discriminating MV reoperation for stenotic and regurgitant MV, respectively.
UNASSIGNED: Age <1 year, tethered leaflets, 2DE postoperative MR, changes in 3D-EOA and 3D-VCRA were all independently associated with MV reoperation. 3DE parameters showed a stronger association than 2DE. 3DE-based decision-tree algorithms may help prognostication and serve as a support tool for clinical decision-making.
UNASSIGNED: The purpose of this study was to investigate the value of 3-dimensional echocardiography (3DE) and identify associations with MV reoperation in this setting.
UNASSIGNED: All children <18 years of age who underwent MV reconstruction for CMVD in 2002 to 2018 were included. Preoperative and postoperative 2-dimensional echocardiography (2DE) and 3DE data were collected. Competing risks and Cox regression analysis were used to identify independent associations with MV reoperation. Receiver operating characteristic and decision-tree analysis were implemented for comparison of 3DE vs 2DE.
UNASSIGNED: A total of 206 children underwent MV reconstruction for CMVD (mitral stenosis, n = 105, mitral regurgitation [MR], n = 75; mixed disease, n = 26); 64 (31%) required MV reoperation. Variables independently associated with MV reoperation were age <1 year (HR: 2.65; 95% CI: 1.13-6.21), tethered leaflets (HR: 2.00; 95% CI: 1.05-3.82), ≥ moderate 2DE postoperative MR (HR: 4.26; 95% CI: 2.45-7.40), changes in 3D-effective orifice area (3D-EOA) and in 3D-vena contracta regurgitant area (3D-VCRA). Changes in 3D-EOA and 3D-VCRA were more strongly associated with MV reoperation than changes in mean gradients (area under the curve [AUC]: 0.847 vs AUC: 0.676, P = 0.006) and 2D-VCRA (AUC: 0.969 vs AUC: 0.720, P = 0.012), respectively. Decision-tree analysis found that a <30% increase in 3D-EOA had 80% accuracy (HR = 8.50; 95% CI: 2.9-25.1) and a <40% decrease in 3D-VCRA had 93% accuracy (HR: 22.50; 95% CI: 2.9-175) in discriminating MV reoperation for stenotic and regurgitant MV, respectively.
UNASSIGNED: Age <1 year, tethered leaflets, 2DE postoperative MR, changes in 3D-EOA and 3D-VCRA were all independently associated with MV reoperation. 3DE parameters showed a stronger association than 2DE. 3DE-based decision-tree algorithms may help prognostication and serve as a support tool for clinical decision-making.
摘要：
■先天性二尖瓣疾病（CMVD）在其医疗和手术管理中提出了重大挑战。
■这项研究的目的是研究3维超声心动图（3DE）的价值，并确定在这种情况下与MV再次手术的关联。
■在2002年至2018年接受了CMVDMV重建的所有年龄<18岁的儿童都包括在内。收集术前、术后二维超声心动图(2DE)和3DE数据。竞争风险和Cox回归分析用于确定与MV再手术的独立关联。为了比较3DE和2DE，实现了接收器工作特性和决策树分析。
■共有206名儿童接受了CMVD的MV重建（二尖瓣狭窄，n=105，二尖瓣反流[MR]，n=75；混合性疾病，n=26)；64(31%)需要MV再操作。与MV再手术独立相关的变量为年龄<1岁(HR:2.65;95%CI:1.13-6.21),系留传单(HR：2.00；95%CI：1.05-3.82)，≥中度2DE术后MR（HR：4.26；95％CI：2.45-7.40），3D有效孔口面积（3D-EOA）和3D静脉收缩反流面积（3D-VCRA）的变化。与平均梯度（曲线下面积[AUC]：0.847vsAUC：0.676，P=0.006）和2D-VCRA（AUC：0.969vsAUC：0.720，P=0.012）的变化相比，3D-EOA和3D-VCRA的变化与MV再手术的相关性更强。分别。决策树分析发现，3D-EOA的<30％增加具有80％的准确性（HR=8.50;95％CI：2.9-25.1），3D-VCRA的<40％减少具有93％的准确性（HR：22.50;95％CI：2.9-175）在区分狭窄和反流的MV时，分别。
■年龄<1岁，拴系的传单，2DE术后MR,3D-EOA和3D-VCRA的改变均与MV再手术独立相关。3DE参数显示出比2DE更强的关联。基于3DE的决策树算法可以帮助预测并用作临床决策的支持工具。
■这项研究的目的是研究3维超声心动图（3DE）的价值，并确定在这种情况下与MV再次手术的关联。
■在2002年至2018年接受了CMVDMV重建的所有年龄<18岁的儿童都包括在内。收集术前、术后二维超声心动图(2DE)和3DE数据。竞争风险和Cox回归分析用于确定与MV再手术的独立关联。为了比较3DE和2DE，实现了接收器工作特性和决策树分析。
■共有206名儿童接受了CMVD的MV重建（二尖瓣狭窄，n=105，二尖瓣反流[MR]，n=75；混合性疾病，n=26)；64(31%)需要MV再操作。与MV再手术独立相关的变量为年龄<1岁(HR:2.65;95%CI:1.13-6.21),系留传单(HR：2.00；95%CI：1.05-3.82)，≥中度2DE术后MR（HR：4.26；95％CI：2.45-7.40），3D有效孔口面积（3D-EOA）和3D静脉收缩反流面积（3D-VCRA）的变化。与平均梯度（曲线下面积[AUC]：0.847vsAUC：0.676，P=0.006）和2D-VCRA（AUC：0.969vsAUC：0.720，P=0.012）的变化相比，3D-EOA和3D-VCRA的变化与MV再手术的相关性更强。分别。决策树分析发现，3D-EOA的<30％增加具有80％的准确性（HR=8.50;95％CI：2.9-25.1），3D-VCRA的<40％减少具有93％的准确性（HR：22.50;95％CI：2.9-175）在区分狭窄和反流的MV时，分别。
■年龄<1岁，拴系的传单，2DE术后MR,3D-EOA和3D-VCRA的改变均与MV再手术独立相关。3DE参数显示出比2DE更强的关联。基于3DE的决策树算法可以帮助预测并用作临床决策的支持工具。
