二尖瓣几何结构与缺血性二尖瓣反流机制的超声影像学研究

Preliminary study of the relationship between the ischemic mitral regurgitation mechanism and geometric structure of the mitral valve in the papillary muscle dysfunction

目的利用经食管超声心动图（TEE）技术研究冠心病患者乳头肌功能不全与二尖瓣反流及二尖瓣前后叶和二尖瓣环几何角度之间的相互关系，探讨左室乳头肌功能不全发生二尖瓣反流的解剖与病理生理学机制。方法将冠心病陈旧性下后壁心肌梗死合并乳头肌功能不全患者及正常对照组共84例作为研究对象，分为健康志愿者对照组40例（A组）、冠心病合并乳头肌功能不全组44例（B组）、二尖瓣外科成形术后组20例（C组，随机选自B组冠心病合并乳头肌功能不全患者），分别利用TEE技术研究二尖瓣前后叶和二尖瓣环间的几何角度与二尖瓣反流量之间的相互关系。结果B组患者二尖瓣前后叶和二尖瓣环间的几何角度均明显增大，且二尖瓣前后叶和二尖瓣环间的几何角度与二尖瓣反流程度呈正相关；C组患者二尖瓣反流量显著减少，且二尖瓣前后叶和二尖瓣环间的几何角度与A组比较差异无统计学意义。结论冠心病患者引起的左室乳头肌功能不全合并二尖瓣反流程度与二尖瓣前后叶和二尖瓣环间的几何角度密切相关，二尖瓣外科修补术可明显减小二尖瓣前后叶和二尖瓣环间的几何角度，从而减轻二尖瓣反流程度。

Objective To study the relationship between ischemic mitral regurgitation and geometric angles of the mitral valve leaflets in patients with coronary artery disease and papillary muscle dysfunction by transesophageal echocardiography（TEE）, and to evaluate anatomy and pathophysiology mechanicm of the ischemic mitral regurgitation with left ventricular papillary muscle dysfunction. Methods A total of 84 subjects were enrolled in this study. All of the subjects were divided into group A （healthy volunteers constituted the control group, n = 40）,group B （chronic inferior or posterior myocardial infarction patients with papillary muscle dysfunction group, n = 44）, group C（patients from group B after mitral valvuloplasty surgery, n = 20）.The relationship between mitral regurgitation and geometric angles of the mitral valve leaflets and mitral annulus were studied by TEE. Results Geometric angle between the mitral valve leaflets and mitral annulus were significantly larger in group B,and geometric angles of the mitral valve leaflets and mitral annulus was positive correlated with degree of mitral regurgitation. Degree of mitral regurgitation significantly reduced in group C, no significant difference was found at the geometric angles of the mitral valve leaflets and mitral valve annular compared with group A. Conclusions The degree of mitral regurgitation were highly correlated with geometric angles of the mitral valve leaflets and mitral valve annular in patients with left ventricular papillary muscle dysfunction caused by coronary heart dlsease.Repair of the mitral valve leaflets surgery can significantly reduce geometric angles of the mitral valve leaflets and mitral valve annular,and reduce the degree of mitral regurgitation significantly.