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      Morphological Evaluation of Mitral Valve Based on Three-dimensional Printing Models: Potential Implication for Mitral Valve Repair


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          Objective: This study aimed to analyze the morphological characteristics of rheumatic (RMVD) and degenerative mitral valve diseases (DMVD) based on three-dimensional (3D) printing model before and after surgery and to explore the potential implication of the 3D printing model for mitral valve (MV) repair.

          Methods: 3D transesophageal echocardiography (TEE) data of the MV were acquired in 45 subjects (15 with RMVD, 15 with DMVD, and 15 with normal MV anatomy). 3D printing models of the MV were constructed by creating molds to be printed with water-soluble polyvinyl alcohol, then filled with room temperature vulcanizing silicone. The parameters of the annulus and leaflet of the MV were acquired and analyzed using the 3D printing model. Mitral valve repair was simulated on 3D printing models of 10 subjects and compared with the actual operation performed on patients. The effects of surgery were assessed by evaluating the changes in coaptation length (CL) and the annular height to commissural width ratio (AHCWR) before and after MV repairs. The correlations of the grade of mitral regurgitation with CL and AHCWR were analyzed.

          Results: 3D silicone MV models were all successfully constructed based on 3D TEE data. Compared with the normal groups, the mitral annulus size in the RMVD groups showed no significant differences. In contrast, mitral annulus in DMVD groups was dilated and flattened with diameters of anteroposterior, anterolateral-posteromedial, commissural width, annular circumferences, and area increased. Mitral repair was successfully simulated on 10 models with significant increase in leaflet coaptation area both in vivo and in vitro. Good agreement was observed in CL and AHCWR after surgery in the 3D printing model compared with real surgery on the patient valve. The grade of mitral regurgitation correlated inversely with CL (r = –0.87, P < 0.01) and AHCWR (r = –0.79, P < 0.01). Mitral valve repair was performed twice in one model to assess which provided a better outcome.

          Conclusions: 3D printing models of the MV based on 3D TEE data could be used in morphological analysis of the MV before and after surgery in RMVD and DMVD. Surgery simulation on 3D printing models could provide valuable information concerning morphological changes after surgery, with are closely associated with clinical outcomes.

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          Most cited references20

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          Rheumatic heart disease

          Rheumatic heart disease, often neglected by media and policy makers, is a major burden in developing countries where it causes most of the cardiovascular morbidity and mortality in young people, leading to about 250,000 deaths per year worldwide. The disease results from an abnormal autoimmune response to a group A streptococcal infection in a genetically susceptible host. Acute rheumatic fever--the precursor to rheumatic heart disease--can affect different organs and lead to irreversible valve damage and heart failure. Although penicillin is effective in the prevention of the disease, treatment of advanced stages uses up a vast amount of resources, which makes disease management especially challenging in emerging nations. Guidelines have therefore emphasised antibiotic prophylaxis against recurrent episodes of acute rheumatic fever, which seems feasible and cost effective. Early detection and targeted treatment might be possible if populations at risk for rheumatic heart disease in endemic areas are screened. In this setting, active surveillance with echocardiography-based screening might become very important. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Guidelines on the management of valvular heart disease (version 2012).

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              Epidemiology of acquired valvular heart disease.

              Population-based studies including systematic echocardiographic examinations are required to assess the prevalence of valvular heart disease. In industrialized countries, the prevalence of valvular heart disease is estimated at 2.5%. Because of the predominance of degenerative etiologies, the prevalence of valvular disease increases markedly after the age of 65 years, in particular with regard to aortic stenosis and mitral regurgitation, which accounts for 3 in 4 cases of valvular disease. Rheumatic heart disease still represents 22% of valvular heart disease in Europe. The prevalence of secondary mitral regurgitation cannot be assessed reliably but it seems to be a frequent disease. The incidence of infective endocarditis is approximately 30 cases per million individiuals per year. Its stability is associated with marked changes in its presentation. Patients are getting older and staphylococcus is now becoming the microorganism most frequently responsible. Heath care-associated infections are the most likely explanation of changes in the microbiology of infective endocarditis. In developing countries, rheumatic heart disease remains the leading cause of valvular heart disease. Its prevalence is high, between 20 and 30 cases per 1000 subjects when using systematic echocardiographic screening. In conclusion, the temporal and geographical heterogeneity illustrates the effect of socioeconomic status and changes in life expectancy on the frequency and presentation of valvular heart disease. A decreased burden of valvular disease would require the elaboration of preventive strategies in industrialized countries and an improvement in the socioeconomic environment in developing countries.

                Author and article information

                BIO Integration
                Compuscript (Ireland )
                December 2021
                30 November 2021
                : 2
                : 4
                : 143-151
                [1] 1Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
                [2] 2Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
                Author notes
                *Correspondence to: Qing Zhou, E-mail: qingzhou.wh.edu@ 123456hotmail.com

                aThese authors contributed equally to this work.

                Copyright © 2021 The Authors

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/). See https://bio-integration.org/copyright-and-permissions/

                : 22 July 2021
                : 18 October 2021
                : 03 November 2021
                Self URI (journal-page): https://bio-integration.org/
                Original Article

                Medicine,Molecular medicine,Radiology & Imaging,Biotechnology,Pharmacology & Pharmaceutical medicine,Microscopy & Imaging
                Mitral repair,3D printing,surgical simulation,transesophageal echocardiography,three-dimensional


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