应用经食管实时三维超声评价缺血性二尖瓣反流及瓣叶形态功能变化的研究

Study of morphology and function in ischemic mitral regurgitation and leaflets by real-time three-dimensional transesophageal echocardiography

目的应用经食管实时三维超声（RT-3D-TEE）和二尖瓣立体结构定量（MVQ）分析软件,对缺血性二尖瓣反流（IMR）的二尖瓣瓣环及瓣叶功能进行评价,筛选出对IMR机制有意义的参数。方法 25例IMR组患者,其中男性14例,女性11例;年龄41~72岁,平均年龄41.7岁。20例正常对照组,其中男性11例,女性9例;年龄37~69岁,平均年龄38.6岁。行RT-3D-TEE技术对2组患者进行检查,应用MVQ分析软件测量并分析2组二尖瓣瓣环及瓣叶几何形态学参数变化特点。结果 IMR组反流容积（46±11）m L,有限反流口面积（0.31±0.12）cm2,说明IMR组存在中度反流。与正常对照组相比,IMR组反映二尖瓣瓣环解剖结构参数如瓣环前外侧交界到后内侧交界的距离（DAIPm）、前叶瓣环中点到后叶瓣环中点的距离（DAP）、瓣环三维周长（C3DE）、绕环最小表面面积（A3Dmin）、环的椭圆度（E2D）及二尖瓣帆状区容积（Vtent）均有所增加（P﹤0.05）;瓣环最高点所在平面与最低点所在平面的高（H）、环高度与联合直径的比率（H/DAIPm）、前后瓣叶对合的参数投影平面中的结合长度（L2DAIPm）及前后叶关闭时对合线的长度（LC3DLf）均有所减低（P﹤0.05）。与正常对照组相比,IMR组前小叶角度（θant）、后小叶角度（θpost）及小叶非平面角度（θnpa）未见明显变化。结论通过RT-3D-TEE能够为缺血性二尖瓣反流患者提供局部二尖瓣瓣环功能或形态异常的量化指标,为临床医生选择个性化治疗方案和疗效评价提供了依据。

Objective To investigate the clinical value of real-time three-dimensional transesophageal echocardiography（RT-3D-TEE） and valve quantitative（MVQ） software in mitral annulus and leaflets of ischemic mitral regurgitation（IMR）, and select the significant parameters in diagnosing IMR. Methods A total of 25 cases of IMR were enrolled in IMR group, which included 14 males and 11 females, aged 41- 72 years old with mean age of 41.7 years old. Twenty cases was set as normal control group,which included 11 males and 9 females, aged 37- 69 years old with mean age of 38.6 years old. The RT-3D-TEE was performed on 2 groups, the variation morphological parameters in mitral annulus and leaflets in 2 groups were measured and analyzed by MVQ software. Results The regurgitation volume of IMR group was（46 ± 11） m L and finite regurgitation orifice area was（0.31 ±0.12） cm2, which indicated that moderate regurgitation was existed in IMR group. Compared with normal control group, the mitral valve anatomic structure parameters in IMR group, such as anterolateral to posteromedial diameter of annulus（DAIPm）, anterior to posterior diameter of annulus（DAP）, three-dimensional perimeter of annulus（C3DE）, minimal area of leaflets within saddle-shaped annulus（A3Dmin）, ellipticity of annulus（E2D） and volume of mitral sail zone（Vtent） increased（P ﹤ 0.05）; The annular height（H）,annular height / anterolateral to posteromedial diameter of annulus（H / DAIPm）, length of diameter of annulus anterior and posterior projection plane（L2DAIPm） and length of anterior and posterior leaflets closed（LC3DLf） were decreased（P 〈 0.05）. Compared with normal control group, there was no obvious changed in anterior leaflet angle（θant）, posterior leaflet angle（θpost） and leaflet non-plane angle（θnpa） of IMR group. Conclusion It is demonstrated that RT-3D-TEE could show quantitative index of IMR patients in abnormal function and morphology of mitral annulus, which provides the basis to personalize treatment and evaluation treatment effect of clinicians.