Functional restructuring of myocardial and cardiac valve apparatus in patients with infectious endocarditis

Aim: to evaluate the relationship between myocardial function and mitral valve insufficiency in patients with IE. Materials and methods.196 patients with valve IE aged from 18 to 84 years (mean age 59.3±2.1 years); men (65%), women (35%) who entered the clinic for surgical treatment were Analyzed. IE emerged against the background of the initial rheumatic heart valve disease in 68 (34.7 %) cases, congenital malformation of the valve apparatus (systemic degenerative diseases of connective tissue, bivalve aortic valve) - in 101 (51.3 %), without previous pathology in 27 (14 %). The study included transthoracic (TTE) and transesophageal echocardiography (TEE) on the devices of expert class (Vivid E 9, 33 Toshiba, Siemens, 2000) with a scanning frequency of 2.4 to 5.5 MHz. The study was based on one-dimensional, two-dimensional and Doppler echocardiography was efficient, including impulsebuy, postanovochnogo, color and fabric techniques, as well as vector analysis of the displacement speeds of the myocardium, a diagram of «flow-volume» rate of change of volume (dVol/dt) during the cardiac cycle in the software package Multivox. Results. The Sensitivity of Echocardiography in detecting IE of prosthetic valves varies widely and the average is 67 %, with raspisanii echocardiography 89 %. False positive results diagnostic vegetaci are observed in the gap of the valves, isolation of the chord, myxomatosis degeneration of the valves etc. Hemodynamic disorders is determined not only by the severity of valve regurgitation, comprising an average of 30-35 % of the value of the stroke output but the state of the LV myocardium. Vector analysis and diagram method revealed that the rate of change in the volume of LV in both systole and diastole is statistically significantly higher in patients with MN on the background of IE before surgery compared with the norm. At the same time, the rate of change in the length (dL/dt (s)) of LV in systole or diastole is practically no different from the norm. Adequate surgical correction of MN is accompanied not only by a decrease in BW and CSR of the left ventricle, but also by normalization dVol/dt, reaching almost normal values (p<0.01). Summary. TEE significantly exceeds the sensitivity of TTE echocardiography in the diagnosis of para-anular valve abscesses, vegetations in secondary ie native and prosthetic heart valves, as well as small - sized vegetations-less than 2 mm. Timely evaluation of myocardial function in IE with failure of MC on the rate of change of the volume in systole (dVol/dt’s) and ejection fraction allows with high probability to assess the risk and efficacy of surgical correction of pathology.

Echocardiography , Endocarditis , Myocardium , Prosthetic heart valves , Valve disease

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