经食管实时三维超声评估二尖瓣成形术患者二尖瓣结构和功能的研究

Research on mitral valve structure and function by transesophageal real-time three-dimensional ultrasound in patients with mitral valvuloplasty

目的 采用经食管实时三维超声(real-time 3D transesophageal echo-cardiography,RT-3DTEE)评估二尖瓣成形术(mitral valve plasty,MVP)患者二尖瓣结构和功能,分析其在临床中的应用价值。方法 选取梧州市工人医院2019年3月至2020年3月收取的47例单纯二尖瓣脱垂行MVP患者的临床资料,在术前及术后3个月患者血流动力学评估稳定后进行RT-3D-TEE检查并保留其影像,测量术前、术后3个月瓣环面积(A2D)、瓣环周长(C3D)、前叶面积(A3DEAnt)、瓣叶暴露面积(A3DE)、后叶暴露面积(A3DEPost)、瓣环最小三维面积(A3Dmin)、脱垂高度(Hprol)、穹隆高度(Htent)、脱垂容积(Vprol)、穹隆容积(Vtent)、瓣叶非平面夹角(θNPA)、前后直径(DAP)、对合指数(CPI)、瓣环收缩功能;采用Person相关性分析二尖瓣关闭不全(MR)程度与CPI及瓣环收缩的相关性,使用受试者工作特征(ROC)曲线评估RT-3D-TEE检测参数对治疗MVP患者的工作效能,计算其曲线下面积(AUC)。结果 MVP患者A2D、C3D、A3DEAnt、A3DE、A3DEPost、A3Dmin、Hprol、Vprol、Vtent、θNPA、DAP、CPI均明显低于术前,差异具有统计学意义(P<0.05);Person相关性分析结果表明,瓣环收缩功能与MR程度呈正相关,CPI与MR程度呈负相关(P>0.05);RT-3D-TEE诊断患者A2D、C3D、Hprol、Htent、Vtent、对合指数、瓣环收缩功能的ROC曲线结果中AUC依次为1.000、0.973、0.982、0.590、0.414、0.987、0.560,敏感度依次为97.9%、91.5%、89.4%、89.4%、51.1%、89.4%、38.3%;特异度依次为100.0%、100.0%、100.0%、34.0%、0.0%、100.0%、93.6%。结论 对MVP患者采用RT-3D-TEE方式评估二尖瓣的结构及功能效果较好,可为临床诊疗提供参考。

Objective Real-time 3D transesophageal echo-cardiography(RT-3D-TEE) was used to evaluate mitral valve structure and function of the patients with mitral valve plasty(MVP) and analyze its clinical effects.Methods The data of 47 patients with simple mitral valve prolapse who received MVP from March 2019 to March 2020 in the hospital were selected,and RT-3D-TEE was performed after the patient’s hemodynamic evaluation and was stable before and 3 months after the operation.Check and preserve its images,measure the annulus area(A2D),annulus circum ference(C3D),anterior leaflet area(A3DEAnt),leaflet exposure area(A3DE),and posterior leaflet exposure area(A3DE) before and 3 months after the operation(A3DEPost),minimum three-dimensional annulus area(A3Dmin),prolapse height(Hprol),dome height(Htent),prolapse volume(Vprol),dome volume(Vtent),leaflet non-planar angle(θNPA),anterior and posterior Diameter(DAP),coaptation index(CPI),annular contraction function;Person correlation was used to analyze the correlation between Mitral valve closure insufficiency(MR) degree and CPI and annular contraction,and Subject operating characteristic(ROC) curve was used to evaluate the effect of RT-3D-TEE detection parameters on the treatment of MVP patients.Work efficiency,calculate the area under the curve.Results A2D,C3D,A3DEAnt,A3DE,A3DEPost,A3Dmin,Hprol,Vprol,Vtent,θNPA,DAP,and CPI in MVP patients were significantly lower than those before the operation,and the difference was statistically significant(P < 0.05);Person correlation analysis of person showed annulus contraction function was positively correlated with the degree of MR,CPI and annulus contraction function.It was positively correlated(P < 0.05),and CPI was negatively correlated with the degree of MR(P > 0.05);RT-3D-TEE diagnosed patients with A2D,C3D,Hprol,Htent,Vtent,anastomosis index,ROC curve of annulus contractility.In the results,the AUC was 1.000,0.973,0.982,0.590,0.414,0.987,0.560,the sensitivity was 97.9%,91.5%,89.4%,89.4%,51.1%,89.4%,38.3%;the specificity was 100.0%,100.0%,100.0%,34.0%,0.0 %,100.0%,93.6%.Conclusion MVP patients use RT-3D-TEE to evaluate structure and function of the mitral valve,which is worthy of providing clinical reference.