Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping.
We assessed vortex patterns and energy loss in left ventricular flow in patients who underwent mitral valve repair or replacement with bioprosthetic valves.



Vector flow mapping was performed before and after the procedure in 15 and 17 patients who underwent repair and replacement, respectively. The preprocedure mitral-septal angle was measured in all patients. Relationships between vortex patterns or energy loss change (ELC) and annuloplasty ring or bioprosthetic valve sizes or the effect of mitral leaflet resection in the repair group were statistically analysed.



Normal vortex patterns were observed in 13 and 1 patients who underwent repair and replacement, respectively. Abnormal vortex patterns were observed in 2 and 16 patients who underwent repair and replacement, respectively. ELC was significantly higher in the replacement group (196.6 ± 180.8) than in the repair group (71.9 ± 43.9). In the repair group, preoperative mitral-septal angles in patients with normal vortex patterns (79.2° ± 3.4°) were significantly larger than those in patients with abnormal vortex patterns (67.5° ± 3.5°). No significant differences were observed in the effects of annuloplasty ring and bioprosthetic valve sizes on vortex patterns and ELC, and in the effect of mitral valve resection (80.4 ± 56.3) and respect (without leaflet resection) (53.8 ± 28.4) on ELC in the repair group.



Mitral valve replacement alters the intraventricular vortex pattern and increases flow energy loss. A small mitral-septal angle is a risk factor for abnormal vortex patterns after mitral valve repair surgery.
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Koichi
K
Akiyama
Department of Statistical Genetics, Kyoto University, Kyoto, Japan.
Naotoshi
N
Nakamura
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Keiichi
K
Itatani
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yoshifumi
Y
Naito
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Mao
M
Kinoshita
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Masaru
M
Shimizu
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Saeko
S
Hamaoka
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideya
H
Kato
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hiroaki
H
Yasumoto
Department of Anesthesiology, Kansai Medical University, Hirakata, Japan.
Yasufumi
Y
Nakajima
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Toshiki
T
Mizobe
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Satoshi
S
Numata
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hitoshi
H
Yaku
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Teiji
T
Sawa
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
Left ventricle; Mitral valve; Mitral valve annuloplasty