经食道三维超声在房颤二尖瓣结构变化对其返流程度影响中的应用

Application of Transesophageal Three-dimensional Ultrasound in the Influence of Mitral Valve Structure Changes on the Degree of Reflux in Atrial Fibrillation

目的经食道三维超声心动图研究房颤患者二尖瓣结构变化对其返流程度影响。方法选取电生理检查、射频消融手术患者66例。根据术前心电图分为阵发性房颤、持续性房颤、非房颤对照三组,分别行经胸二维超声检查,获得左房舒张末内径、左室舒张末内径、二尖瓣返流量,除外心脏瓣膜病、左心室扩大相关疾病、先心等病例。根据二尖瓣返流程度将其分为轻微返流、轻度返流、中度返流三组。行食道三维超声检查,应用MVQ软件进行二尖瓣量化分析,分别获得瓣环前后径、瓣环前外-后内径、瓣环高度、瓣叶非平面交角、前叶交角、后叶交角等二尖瓣参数。结果对照组与持续性房颤组,对照组与阵发性房颤组之间DAIPm、H对比,差异有统计学意义(P<0.05);DAIPm、H在阵发性房颤组与持续性房颤组,差异无统计学意义(P>0.05);NAP、θANT、θPOST在持续性房颤、阵发性房颤、对照组,差异无统计学意义(P>0.05);DAP、DAIPm在MR轻微组与中度组间比较,差异有统计学意义(P<0.05);H、θNAP、θANT在不同程度MR,差异无统计学意义(P>0.05);θPOST不同程度MR间对比,差异有统计学意义(P<0.05)。结论房颤患者二尖瓣后叶交角的增大常预示其功能性二尖瓣返流的增加,二尖瓣后叶交角对评估其反流程度有一定意义。

Objective To investigate the effect of mitral valve structure changes on the degree of reflux in patients with atrial fibrillation by transesophageal three-dimensional echocardiography.Methods 66 patients undergoing electrophysiological examination and radiofrequency ablation were selected.Three groups were divided into paroxysmal atrial fibrillation,persistent atrial fibrillation and non atrial fibrillation,and the left atrium diastolic diameter,left ventricular end diastolic diameter and mitral regurgitation were obtained respectively,except for heart valvular disease,left ventricular enlargement related diseases and preheart cases.According to the degree of mitral regurgitation,they were divided into three groups：mild reflux,mild regurgitation and moderate reflux.Three-dimensional ultrasonography of the esophagus was performed and mitral valve quantification was performed using MVQ software.The anterior diameter of the annulus,the anterior-posterior diameter of the annulus,the height of the annulus,the non-planar angle of the leaflet,the angle of the anterior leaf,and the angle of the posterior lobe were obtained. Results There were significant differences in DAIPm and H between control group and persistent AF group and control group and paroxysmal atrial fibrillation group（ P〈0.05）.There was no significant difference in the DAIPm,H between paroxysmal atrial fibrillation and persistent AF（ P〉0.05）;NAP,θANT,and θPOST in persistent atrial fibrillation,paroxysmal atrial fibrillation,control group,no difference Statistical significance（ P〉0.05）;DAP and DAIPm were significantly different between MR mild group and moderate group（P 0.05）;H,θNAP,and θANT were different in MR,with no significant difference（P〉0.05）;θPOST varying degrees of MR contrast,the difference was statistically significant（P〈0.05）.Conclusion The increase of the angle of the mitral valve in the AF of patients with atrial fibrillation often predicts the increase of functional mitral regurgitation.The angle of the posterior mitral valve has a certain significance for assessing the degree of regurgitation.