三维超声心动图分析瓣膜解剖结构作为房室间隔缺损手术后二尖瓣反流的决定因素

Three-dimensional echocardiographic analysis of valve anatomy as a determinant of mitral regurgitation after surgery for atrioventricular septal defects.

作者信息

Acar P, Laskari C, Rhodes J, Pandian N, Warner K, Marx G

机构信息

Pediatric Cardiology, Tuft-New England Medical Center, Boston, Massachusetts, USA.

出版信息

Am J Cardiol. 1999 Mar 1;83(5):745-9. doi: 10.1016/s0002-9149(98)00982-5.

DOI:10.1016/s0002-9149(98)00982-5

PMID:10080430

Abstract

Mitral regurgitation (MR) is a significant complication after atrioventricular septal defect (AVSD) surgery. The relation of the valve leaflet morphology and the MR mechanism remains a conundrum. Two-dimensional echocardiography depicts leaflet edges, whereas volume-rendered 3-dimensional echocardiography provides direct visualization of the surface areas of the mitral valve leaflets. This study examines the relation of mitral valve anatomy as determined by 3-dimensional echocardiography with MR origins in patients after AVSD repair. Twenty-seven patients with AVSD surgery and Doppler color MR were prospectively enrolled (median age was 5 years and 16 patients had Down syndrome). Doppler color flow imaging of the MR jet and 3-dimensional echocardiography of the mitral valve were performed with a probe in the transthoracic or transesophageal position. Enface 3-dimensional views of the mitral valve from the left atrium were reconstructed. Analysis of the 3-dimensional data was possible in 21 of the 27 patients. Mean area ratios of the 3 mitral leaflets were calculated (superior 40 +/- 7%, inferior 35 +/- 5%, mural 25 +/- 6%). Both intra and interobserver variability on the area measurements were <5%. In 12 patients (group 1) the jet appeared to emanate medially from the region of coaptation of the superior and inferior components of the anterior leaflet. In 9 patients (group 2) the jet emanated more laterally from the region toward the mural leaflet. The area ratios of the inferior leaflet were 32 +/- 4% in group 1 and 38 +/- 6% in group 2 (p = 0.02). The area ratios of the mural leaflet were 28 +/- 5% in group 1 and 21 +/- 5% in group 2 (p = 0.007). The superior leaflet area ratio was not different in groups 1 and 2, 40 +/- 9% and 41 +/- 6%, respectively. Three-dimensional echocardiography provides new insight into the anatomic determinants of MR following AVSD surgery.

摘要

二尖瓣反流（MR）是房室间隔缺损（AVSD）手术后的一种重要并发症。瓣膜小叶形态与MR机制之间的关系仍然是一个难题。二维超声心动图描绘小叶边缘，而容积再现三维超声心动图可直接显示二尖瓣小叶的表面积。本研究探讨三维超声心动图确定的二尖瓣解剖结构与AVSD修复术后患者MR起源之间的关系。前瞻性纳入27例接受AVSD手术且有多普勒彩色MR的患者（中位年龄5岁，16例患有唐氏综合征）。使用经胸或经食管探头对MR射流进行多普勒彩色血流成像，并对二尖瓣进行三维超声心动图检查。从左心房重建二尖瓣的正面三维视图。27例患者中有21例可进行三维数据分析。计算3个二尖瓣小叶的平均面积比（上方40±7%，下方35±5%，侧壁25±6%）。面积测量的观察者内和观察者间变异性均<5%。在12例患者（第1组）中，射流似乎从前叶上、下部分的贴合区域内侧发出。在9例患者（第2组）中，射流从该区域更外侧朝向侧壁小叶发出。第1组下方小叶的面积比为32±4%，第2组为38±6%（p = 0.02）。第1组侧壁小叶的面积比为28±5%，第2组为21±5%（p = 0.007）。第1组和第2组上方小叶面积比无差异，分别为40±9%和41±6%。三维超声心动图为AVSD手术后MR的解剖学决定因素提供了新的见解。