目的：探讨实时三维经食管超声心动图（RT-3DTEE）定量评价二尖瓣脱垂（MVP）患者的瓣叶及瓣环功能。方法：选取二尖瓣（MV）形态及功能正常者29例， MVP患者24例，MVP组中根据美国超声心动图协会指南，分为轻度二尖瓣反流（MR）组10例，中重度MR组14例。采用RT-3DTEE定量MV参数，应用MV定量分析软件进行数据分析。结果：MVP患者MV对合储备显著减低，且随MR的加重而进一步减低；瓣叶储备代偿性增加，随MR的增加而增加；MV瓣环收缩功能在轻度反流时无明显改变，在中重度反流时减低。结论：RT-3DTEE技术能定量评价MVP患者的瓣叶及瓣环功能，为深入研究MV功能提供客观理论依据，为手术精确设计提供重要参考信息，为临床工作提供指导意义。
Abstract
Objective: To assess the mitral valve(MV) leaflet and annular function quantitatively in patients with mitral valve prolapse(MVP) using real-time three-dimensional transesophageal echocardiography(RT-3DTEE). Methods: RT-3DTEE of the MV was acquired in 53 subjects, including 14 patients with MVP and significant mitral regurgitation(MR)(moderate to severe MR group), 10 patients with MVP but no or mild MR(mild MR group), and 29 control subjects. The 3-dimensional geometry of MV apparatus was measured with dedicated quantification software. Results: Compared with the normal group, MVP group had more reduced MV coaptation reserve, greater MV leaflet reserve. Compared with the mild MR group, moderate to severe MR group had more reduced MV coaptation reserve, greater MV leaflet reserve. The parameter of annular contraction had no significant differences between the mild MR group and the control group, and this parameter in the moderate to severe MR group was significantly reduced compared with the control group. Conclusion: The MV leaflet and annular function can be assessed quantitatively by RT-3DTEE, which can provide evidence for the assessment of MV function and the design of surgery program.
关键词
二尖瓣脱垂 /
超声心动描记术 /
多普勒 /
彩色
Key words
Mitral valve prolapse /
Echocardiography, Doppler, color
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation[J]. Lancet, 2009, 373(4): 1382-1394.
[2]陈昕，杨军，孙丹丹，等. 实时三维经食管超声心动图对二尖瓣脱垂瓣叶立体结构的定量研究[J]. 中国超声医学杂志，2011，9（9）：793-795.
[3]Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused Update Incorporated In to the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons[J]． J Am Coll Cardiol, 2008, 52(13): 1-142．
[4]Little SH, Ben Zekry S, Lawrie GM, et al. Dynamic annular geometry and function in patients with mitral regurgitation: Insight from three-dimensional annular tracking[J]. J Am Soc Echocardiogr, 2010, 23(8): 872-879.
[5]Suri RM, Schaff HV, Dearani JA. Survival advantage and improved durability of mitral repair for leaflet prolapsed subsets in the current era[J]. Ann Thorac Surg, 2006, 82(3): 819-826.
[6]Sugeng L, Shernan SK, Salgo IS. Live 3-dimensional transesophageal echocardiography． Initial experience using the fully-sampled matrix array probe[J]． J Am Coil Cardiol, 2008, 52(6): 446-449.
[7]Gupta V, Barzilla JE, Mendez JS, et al. Abundance and location of proteoglycans and hyaluronan within normal and myxomatous mitral valves[J]. Cardiovasc Pathol, 2009, 18(4): 191-197.
[8]Lee AP, Hsiung MC, Salgo IS, et al． Quantitative analysis of mitral valve morphology in mitral valve prolapase with real-time 3-dimensional echocardiography: Importance of annular saddle shape in the pathogenesis of mitral regurgitation[J]. Circulation, 2013, 127(7): 832-841.
[9]Cobey FC, Swaminathan M, Phillips-Bute B, et al. Quantitative assessment of mitral valve coapation using three-dimensional transesophageal echocardiography[J]. Ann Thorac Surg, 2014, 97(6): 1998-2004.
[10]Saito K, Okura H, Watanabe N, et al. Influence of chronic tethering of the mitral valve on mitral leaf let size and coaptation in functional mitral regurgitation[J]. JACC Cardiovasc Imaging, 2012, 5(4): 337-345.
[11]Khabbaz KR, Mahmood F, Shakil O, et al. Dynamic 3-Dimensional echocardiographic assessment of mitral annular geometry in patients with functional mitral regurgitation[J]. Ann Thorac Surg, 2013, 95(1): 105-110.
[12]Rausch MK, Bothe W, Kvitting JP, et al. Characterization of mitral valve annular dynamics in the beating heart[J]. Ann Biomed Eng, 2011, 39(6): 1690-1702.
[13]Kaplan SR, Bashein G, Sheehan FH, et al. Three dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve[J]. Am Heart J, 2000, 139(3): 378-387.
[14]Timek TA, Miller DC. Experimental and clinical assessment of mitral annular area and dynamics: What are we actually measuring?[J]. Ann Thorac Sug, 2001, 72(3): 966-974.
[15]Chen X, Sun D, Yang J, et al. Preoperative assessment of mitral valve prolapse and chordae rupture using real time three-dimensional transesophageal echocardiography[J]. Echocardiography, 2011, 28(9): 1003-1010.
基金
沈阳市科技计划项目基金，项目编号：F15-199-1-32。
