经食管实时三维超声心动图对建立主动脉瓣简化模型的研究

Study on the establishment of a simplified model of aortic valve by real time three dimensional echocardiography

目的应用经食管实时三维超声心动图(RT 3DTEE)及其定量软件对主动脉瓣(AV)三维结构的重要参数进行测量,分析各部分的形态及生理特点,进一步建立AV简化模型,为AV成形环的设计提供客观依据。方法选取2014年5月至2015年11月95例行RT 3DTEE检查的主动脉根部正常的人群,采集主动脉根部实时三维全容积图像,应用QLAB7.0瓣环定量分析软件测量舒张末期、收缩中期、收缩末期及舒张中期的三维AV的重要参数,包括窦管交界直径(S)、相邻瓣膜交界的距离(L、R、N)、瓣膜交界构成三角形外接圆直径(J)、AV高度(H)、AA长径(A)、AA短经(B)及AA偏心率(B/A)。分析三维AV底部与AA的延续关系,简化三维AV各结构特点,建立几何模型。结果各参数均以舒张末期为例,窦管交界为(26.3±3.3)mm,三维AV高度为(12.4±1.9)mm,AA长径、短经分别为(25.9±2.7)、(19.8±2.0)mm,相邻瓣膜交界间距离L、R、N均为(21.6±2.5)mm,三者所构成的图形近似等边三角形。比较相邻周期时相的窦管交界直径、AV高度、AA长径、三个相邻瓣膜交界间距离及它们的外接圆直径,差异均无统计学意义(P>0.05),但舒张末期与收缩中期AA短径及AA短径与长径比值比较,差异均有统计学意义(P<0.01)。结论 RT 3DTEE及瓣环定量分析软件能准确测量AV各部分的大小并显示其形态,及其在不同周期时相间的变化,进而三维AV形态的简化与重建。

Objective To detect the important parameters of three dimensional structure of the aortic annulus by using real time three dimensional transesophageal echocardiograhy （RT 3D TEE） and analyse morphological and physiological characteristics , in order to establish simplified model of aortic valve and provide references for designing aortic annulus .Methods A total of 95 ca‐ses of healthy individuals carrying out RT 3D TEE were selected ,and the images of total volume of aortic root were collected .The important parameters of three dimensional aortic valve in four cardiac cycles ,including sinus tube junction（S） ,distance between ad‐jacent valve junction（L ,R and N） ,diameter of the circumcircle of triangle（J） ,aortic annulus height（H） ,long diameter（A） ,short di‐ameter（B） and eccentricity ratio （B/A） of the aortic valve ,were measured by using the QLAB7 .0 software .In the 3D imaging ,the extending relationship between the bottom of aortic valve and aortic annulus was analysed ,the structural characteristics of the aortic valve were simplified ,and the model was established .Results The values of the parameters measured at the end‐diastole were as follows ：sinus tube junction （26 .3 ± 3 .3）mm ,three‐dimensional aortic annulus height（12 .4 ± 1 .9）mm ,aortic valve long diameter and short diameter （25 .9 ± 2 .7）mm and （19 .8 ± 2 .0）mm ,adjacent valve junction distance（L ,R and N） all was（21 .6 ± 2 .5）mm . These three structures approximately formed an equilateral triangle .The values of the adjacent cycle time ,the change of sinus tube junction ,distance between adjacent valve junction ,aortic annulus height and long diameter were compared ,and there was no statisti‐cal significant differences（P〉0 .05） ,while statistically significant differences were found in the aortic valve short diameter and long short diameter between those at the end‐diastole and those at the medium‐systole（P〈0 .01） .Conclusion RT 3D TEE can accu‐rately measure the size of each part of the aortic valve and display its shape and change ,which contribute to simplifying and recon‐structing the aortic annlus .