经食管实时三维超声定量评价二尖瓣瓣环在功能性与器质性二尖瓣反流时的形态变化

Changes of mitral annulus dynamics in ischemic and organic mitral regurgitation by real-time three-dimensional transesophageal echocardiography

目的使用经食管实时三维超声(RT-3D-TEE)对比分析正常二尖瓣瓣环与缺血性心肌病、二尖瓣脱垂(器质性瓣膜病)所致中度以上二尖瓣反流(MR)时二尖瓣瓣环的形态及变化规律,探讨不同病因致二尖瓣反流时瓣环变化规律,为外科二尖瓣成形术提供依据。方法对入选10例正常人(对照组)、8例缺血性心肌病(缺血组)及8例二尖瓣脱垂伴中度以上二尖瓣反流病例(脱垂组)进行经食管实时三维超声心动图检查,获取完整心动周期内的实时三维图像,并使用3D-QLAB软件后处理分析二尖瓣瓣环的不同参数。结果 (1)缺血组与对照组在瓣环投影面积变化率、瓣环周长变化率及高度变化率方面差异有统计学意义(P<0.05),但在瓣环最大投影面积、瓣环最大高度、瓣环最大周长及瓣环最大内径(前后径及左右径)方面差异无统计学意义;(2)二尖瓣脱垂组与对照组在各瓣环参数方面差异无统计学意义。结论经食管实时三维超声心动图定量评价二尖瓣瓣环形态及运动变化规律是可行的。缺血性二尖瓣反流与二尖瓣脱垂患者二尖瓣瓣环形态运动变化规律有明显不同,RT-3D-TEE能够定量评价二尖瓣瓣环形态及运动变化规律,为外科二尖瓣成形术提供依据。

Objective To quantitatively assess the change of mitral annulus （MA） in different disease, the MA in three groups, including healthy subjects, patients（pts） without middle ischemic mitral regurgitatin（IMR） and patients（pts） without middle organic MR（mitral valve prolapse, MVP） were contrastively analysed. Methods The real-time three-dimensional transesophageal echocardiography （RT-3D-TEE） was performed in 10 healthy subjects, 8 patients with middle IMR, 8 patients with middle MR from MVP. Results The significant difference （ P 〈 0.05 ） between IMR group and control group in the following parameters was observed： MA projected area change rate, MA perimeter change rate and MA height change rate; but no significant difference in MA projected area, MA perimeter and MA height. There was no significant difference between MVP group and control group. Conclusions The MA tracking was feasible in all subjects. There was significant difference between IMR and MVP group in the motor function of MA. By using RT-3D-TEE, we can quantitatively assess the change of mitral annulus （MA） in different diseases, which could provide evidence for surgical mitral valvuloplasty.