超声心动图在二尖瓣重建术方法选择中的应用

PREOPERATIVE DECISION MAKING OF MITRAL VALVE RECONSTRUCTION BY ECHOCARDIOGRAPHY

对２９例行二尖瓣重建术者，超声心动图上二尖瓣环大小、瓣膜在对合区的形态和手术方法的选择进行对照研究。结果发现，二尖瓣重建术者的超声心动图特征可分为四型。超声分型与二尖瓣重建术方法的选择有直接的关系。本研究为二尖瓣返流的木前诊断提供了一个逻辑判断法，并增加了外科医生选用二尖瓣重建术的能力。

Current preference for valve repair in patients with mitral regurgitation requires that more surgeons improve their technical expertise. Echocardiography has become the principal method for imaging of valvular pathology. But traditional echocardiographic analysis of valves concentrates on the description of abnomalities of leaflet motion such as prolapse,whereas surgery aims at correction of leaflet edges coaptation.To integrate these different approaches,the echocardiographic features of 29 patients with incompetent mitral valves,the findings on direct inspection, and the types of repair performed were analyzed and the zones of coaptation of the mitral valves were studied in a series of parasternal long-axis views.Four patterns of leaflet closure were found:Normal apart from a dilated annulns(17.2%);normal apposition but deficient coaptation(17.27%);asymmetrical apposition but intact coaptation (20.8%);and abnormal apposition and deficient coaptation(44.8%).The patternt of leaflet closure showed a direct relationship between echocardiographic findings and the types of reconstructive techniques which were used.This echocardiographic analysis offers a logical approach to the preoperative diagnosis of regurgitant mitral valves,and provides the surgeon more appropriate selection from the full spectrum of reconstructive techniques.