经食管实时三维超声检测风湿性心脏病患者二尖瓣对合指数的研究

Real-time 3-dimensional transesophageal echocardiography assesses mitral valve coaptation index in patient with rheumatic heart disease

目的:应用经食管实时三维超声心动图检测风湿性心脏病(RHD)患者二尖瓣对合指数,探讨其定量二尖瓣对合程度的可行性及临床价值。方法:选取合并有二尖瓣反流的RHD患者16例作为RHD组,无瓣膜病变且无瓣膜反流的志愿者16例作为对照组。①2组均行经食管实时三维超声心动图检查,应用二尖瓣定量分析程序对三维原始图像进行脱机分析,对相同时相的二尖瓣瓣叶及瓣环进行逐帧描记,分别获取2组在收缩末期及舒张早期的二尖瓣瓣叶面积、瓣环三维周长、瓣环二维投影面积。计算出2组的二尖瓣对合面积及对合指数。②2组均行常规超声心动图检查,测量2组舒张末期左室内径、收缩末期左室内径、左房内径及左室射血分数,并测量RHD组二尖瓣反流面积。结果:RHD组与对照组均能成功得到二尖瓣对合面积并可以计算出二尖瓣对合指数,且RHD组的对合指数明显小于对照组[(10.4±2.8)%:(28.1±3.8)%,P<0.001]。2组的前瓣叶对合指数均小于后瓣叶(RHD组P=0.03,对照组P=0.075)。RHD组的二尖瓣瓣叶面积、左房内径、瓣环三维周长、瓣环二维投影面积均大于对照组(均P<0.01)。结论:应用经食管实时三维超声心动图技术及相关二尖瓣定量分析程序可得到二尖瓣对合指数。合并有二尖瓣反流的RHD患者二尖瓣对合指数明显小于正常人。因此该参数可作为定量评估RHD患者二尖瓣对合程度的形态学指标。

Objective：To investigate the mitral valve coaptation index（MVCI） in patients with rheumatic heart disease by using real-time 3-dimensional transesophageal echocardiography（RT-3D-TEE） and assess the clinical significance of MVCI. Method：There were sixteen patients with mitral regurgitation（MR） as RHD group and 16 normal controls without mitral disease as control group in this study.①The RT-3D-TEE examinations were performed in all cases.All 3-dimensional echocardiographic data were off-line analyzed using mitral valve quantitatiion（MVQ） software.The mitral leaflets and annulus were traced handly in the same phase.The mitral valve area（MVA）,3-dimensional circumference of mitral annulus（C3D） and 2-dimensional area of mitral annulus（A2D） of all cases were obtained in the end-systolic and early-diastolic.②With the conventional echocardiography,the LVIDd,LVIDs,LA and LVEF were measured in all cases,and the MR were measured in rheumatic patients. Result：The MVCA and MVCI were successfully obtained in all cases.Compared with control group,the MVCI was significantly lower（P0.001） in RHD group.The MVCI was（10.4±2.8）% in RHD group and was（28.1±3.8）% in control group.The MVCI of anterior leaflet was lower than the one of posterior leaflet in all cases（patients P=0.03,controls P=0.075）.The MVA,LA,C3D and A2D in RHD group were significantly higher than those in control group（P0.01）. Conclusion：The MVCI can be obtained using RT-3D-TEE and MVQ software with high feasibility.The MVCI of rheumatic patients with MR is lower than-that of normals.So the MVCI can be a morphology indicator to quantitatively assess the mitral valve cooperation in rheumatic patients.