De Simone R, Glombitza G, Vahl C F, Albers J, Meinzer H P, Hagl S
Department of Cardiac Surgery, University of Heidelberg, Deutsches Krebsforschungszentrum, Germany.
Ann Thorac Surg. 1999 Feb;67(2):494-9. doi: 10.1016/s0003-4975(98)01096-0.
Color Doppler echocardiography is a standard technique for assessing mitral regurgitation before and after mitral valvuloplasty. Mitral valve prolapse produces complex eccentric jet flows that cannot be visualized and measured by two-dimensional color Doppler echocardiography. The aim of this study was to evaluate the clinical impact of three-dimensional color Doppler echocardiography, a new technique developed at our institution, for assessing mitral regurgitation.
Forty-five patients with mitral regurgitation underwent intraoperative transesophageal echocardiography and three-dimensional Doppler data acquisition. The grade of mitral regurgitation was assessed by angiography. The jet areas were calculated by planimetry from conventional color Doppler; the jet volumes were obtained by three-dimensional Doppler data.
New patterns of mitral regurgitant flows were recognized according to the origin, direction, and spatial spreading into the left atrium. Conventional jet areas failed to separate the groups of patients with different degrees of regurgitation, whereas the jet volumes were able to divide patients with different regurgitation grades. No significant correlation was found between jet area and angiographic grading (r = 0.63, p = NS). Jet volumes were significantly correlated to angiography (r = 0.89, p < 0.001).
Three-dimensional color Doppler echocardiography revealed new patterns of regurgitant flow and allowed a more accurate semiquantitative assessment of complex asymmetrical regurgitant jets.
彩色多普勒超声心动图是评估二尖瓣成形术前和术后二尖瓣反流的标准技术。二尖瓣脱垂会产生复杂的偏心射流，二维彩色多普勒超声心动图无法对其进行可视化和测量。本研究的目的是评估我院开发的新技术三维彩色多普勒超声心动图在评估二尖瓣反流方面的临床影响。
45例二尖瓣反流患者接受了术中经食管超声心动图检查和三维多普勒数据采集。通过血管造影评估二尖瓣反流的程度。通过传统彩色多普勒的平面测量法计算射流面积；通过三维多普勒数据获得射流容积。
根据二尖瓣反流的起源、方向和在左心房内的空间扩散情况，识别出了新的反流模式。传统的射流面积无法区分不同程度反流的患者组，而射流容积能够区分不同反流程度的患者。射流面积与血管造影分级之间未发现显著相关性（r = 0.63，p = 无显著性差异）。射流容积与血管造影显著相关（r = 0.89，p < 0.001）。
三维彩色多普勒超声心动图揭示了反流的新模式，并能对复杂的不对称反流束进行更准确的半定量评估。
