CAJ | 학술논문

目的采用经食管实时三维超声心动图(RT-3D-TEE)对缺血性二尖瓣反流(IMR)和非缺血性二尖瓣反流(NIMR)患者二尖瓣瓣叶及瓣环三维几何构型进行对比研究,探讨不同病因致二尖瓣反流时瓣叶及瓣环形态变化规律,为心脏外科手术治疗提供依据.方法 98例行RT-3D-TEE检查的患者,分为3组:IMR组43例,NIMR组33例,无二尖瓣反流组(正常对照组)22例.所有患者均在局部麻醉下行RT-3D-TEE检查,分别采集二尖瓣环与瓣叶结构的全容积三维动态超声图像,运用Qlab 7.0 MVQ软件对图像进行脱机分析,获得三维小叶面积(A3DE)、前小叶面积(A3DE Ant)、后小叶面积(A3DE Post)、二尖瓣瓣环周长(C3D)、瓣环前外侧至后内侧直径(DAlPm)、瓣环前后直径(DAP)、二尖瓣瓣环高度(H)、最大脱垂高度(HProl)、最大遮盖高度(HTent)、小叶脱垂体积(Vprol)、小叶遮盖体积(Vtent)、主动脉口二尖瓣环平面夹角(θ)、前小叶角度(θAnt)、非平面小叶角度(θNPA)、后小叶角度(θPost)等二尖瓣环及瓣叶的各项形态学参数测值,并进行统计分析.结果与对照组相比,IMR组的A3DE、A3DE Ant、DAP以及θNPA均明显增大,θ和θPost减小,差异具有统计学意义(P＜0.05);与对照组相比,NIMR组的A3DE、A3DE Ant、DAP、HProl、Vprol以及θNPA均明显增大,θ、θAnt以及θPost减小,差异具有统计学意义(P＜0.05);与NIMR组相比,IMR组的A3DE、A3DE Ant、DAP、Hprol以及θNPA均较小,θAnt以及θPost均较大,差异具有统计学意义(P＜0.05).结论 IMR组及NIMR组均可导致二尖瓣瓣环扩张、瓣叶面积增大,以及瓣环几何构型改变,整个瓣环倾向于扁平化,以上改变在NIMR组比IMR组更明显,且NIMR组出现脱垂更为常见.提示相比IMR组,NIMR组瓣叶及瓣环的损害可能更为严重.
목적 채용경식관실시삼유초성심동도(RT-3D-TEE)대결혈성이첨판반류(IMR)화비결혈성이첨판반류(NIMR)환자이첨판판협급판배삼유궤하구형진행대비연구,탐토불동병인치이첨판반류시판협급판배형태변화규률,위심장외과수술치료제공의거.방법 98례행RT-3D-TEE검사적환자,분위3조:IMR조43례,NIMR조33례,무이첨판반류조(정상대조조)22례.소유환자균재국부마취하행RT-3D-TEE검사,분별채집이첨판배여판협결구적전용적삼유동태초성도상,운용Qlab 7.0 MVQ연건대도상진행탈궤분석,획득삼유소협면적(A3DE)、전소협면적(A3DE Ant)、후소협면적(A3DE Post)、이첨판판배주장(C3D)、판배전외측지후내측직경(DAlPm)、판배전후직경(DAP)、이첨판판배고도(H)、최대탈수고도(HProl)、최대차개고도(HTent)、소협탈수체적(Vprol)、소협차개체적(Vtent)、주동맥구이첨판배평면협각(θ)、전소협각도(θAnt)、비평면소협각도(θNPA)、후소협각도(θPost)등이첨판배급판협적각항형태학삼수측치,병진행통계분석.결과 여대조조상비,IMR조적A3DE、A3DE Ant、DAP이급θNPA균명현증대,θ화θPost감소,차이구유통계학의의(P＜0.05);여대조조상비,NIMR조적A3DE、A3DE Ant、DAP、HProl、Vprol이급θNPA균명현증대,θ、θAnt이급θPost감소,차이구유통계학의의(P＜0.05);여NIMR조상비,IMR조적A3DE、A3DE Ant、DAP、Hprol이급θNPA균교소,θAnt이급θPost균교대,차이구유통계학의의(P＜0.05).결론 IMR조급NIMR조균가도치이첨판판배확장、판협면적증대,이급판배궤하구형개변,정개판배경향우편평화,이상개변재NIMR조비IMR조경명현,차NIMR조출현탈수경위상견.제시상비IMR조,NIMR조판협급판배적손해가능경위엄중.
Objective To quantitatively assess the geometry configuration of mitral valve and annulus in the ischemic mitral regurgitation(IMR) and non-ischemic mitral regurgitation(NIMR) by real-time threedimensional transesophageal echocardiography (RT-3D-TEE),and provide a basis for surgical cardiac surgery.Methods 98 patients undergone RT-3D-TEE examination were enrolled in this study,and were divided into three groups:IMR group (n =43),NIMR group (n =33),and no mitral regurgitation group (control group,n =22).Full-volume 3D dynamic images of mitral annulus and valve were obtained.The images were off-line analyzed using Qlab 7.0 MVQ workstation,and the geometry indexes:area of leaflets (A3DE),area of anterior leaflet (A3DE Ant),area of posterior leaflet (A3DE Post),perimeter of annulus (C3D),anterolateral to posteromedial diameter of annulus (DAlPm),anterior to posterior diameter of annulus (DAP),annulus height (H),maximal prolapse height (HProl),maximal tenting height (HTent),volume of leaflet prolapse (Vprol),volume of the leaflets tent (Vtent),Aortic orifice to mitral plane angle (θ),angle of anterior leaflet (θAnt),non-planar angle of leaflets (θNPA),angle of posterior leaflet (θPost)and other mitral valve leaflets and annulus,were derived and statistically analyzed.Results Compared with the control group,significant increases of A3DE,A3DE Ant,DAP and θPost,and decreases of θ and θNPA were demonstrated in IMR group,the differences were statistically significant (P ＜ 0.05).Significant increases of A3DE,A3DE Ant,DAP,HProl,Vprol and θNPA,and decreases of θ,θAnt and θPost were explored in NIMR group,the differences were statistically significant (P ＜0.05).Compared with NIMR group,a reduction of A3DE,A3DE Ant,DAP,HProl and θNPA,and increases of θAnt and θPost were found in IMR group and the differences were statistically significant (P ＜0.05).Conclusions Both IMR group and NIMR group could lead to mitral annulus dilatation,leaflets area increase,and mitral annulus geometry change,the overall mitral annulus tends to flatten were more obvious in the NIMR group than those in IMR group.The prolapse is more prominent in NIMR group than those in IMR Group.The difference of mitral annulus geometry between IMR group and NIMR group indicates that the damage of the mitral leaflets and annulus might be more serious in NIMR group.