Fyrenius A, Engvall J, Janerot-Sjöberg B
Department of Medicine and Care, Clinical Physiology, Linköping Heart Center, University Hospital, Sweden.
J Heart Valve Dis. 2001 Mar;10(2):146-52.
A dilated or abnormally shaped mitral annulus is a common cause of mitral valve regurgitation, and may be cured by annuloplastic surgery. Multiplane transesophageal echocardiography (TEE) is the diagnostic technique of choice. Our aim was to evaluate and suggest two-dimensional TEE reference values from a standardized procedure of measuring the mitral annular major and minor axes, and their cyclic changes.
The annulus was approximated elliptic in the horizontal plane. The intercommissural (IC, major axis) and anteroposterior (AP, minor axis) distances were measured at end-systole (ES), at maximal valve opening (MO), and at end-diastole (ED) from a mid-esophageal view, in 13 men and eight women with normal echocardiographic findings. Indexed values and reproducibility were calculated.
The success rate was 100% at ES, 90% at MO, and 29% at ED. ES distances were largest (p <0.001) and most reproducible (5-5.9%). Body weight, but not height or age, had a significant impact. ES 95% prediction intervals for IC were 27 to 46 mm (16-23 mm/m2) and 22 to 36 mm (13-18 mm/m2) for AP (p <0.001). Corresponding body weight-corrected intervals were 0.39 to 0.59 (IC) and 0.32 to 0.48 (AP) mm/kg. No subject had IC:AP <1.1 together with an AP >0.45 mm/kg.
Among measurements made at ES, MO and ED, those at ES provided the most reproducible results, and high-quality images were obtained in normal, non-obese subjects. The distances should be judged in relation to body weight or surface area and each other. The largest IC distance and the most elliptic shape were at ES, while the annulus was minimal at ED. The procedure and normal ranges presented may contribute to the evaluation of patients with mitral regurgitation.
二尖瓣环扩张或形态异常是二尖瓣反流的常见原因，可通过瓣环成形手术治愈。多平面经食管超声心动图（TEE）是首选的诊断技术。我们的目的是通过测量二尖瓣环长轴和短轴的标准化程序及其周期性变化，评估并提出二维TEE参考值。
在水平面上，二尖瓣环近似为椭圆形。从食管中段视图，在13名男性和8名超声心动图检查结果正常的女性中，于收缩末期（ES）、最大瓣膜开放时（MO）和舒张末期（ED）测量瓣叶间（IC，长轴）和前后径（AP，短轴）距离。计算指数值和可重复性。
ES时成功率为100%，MO时为90%，ED时为29%。ES距离最大（p<0.001）且可重复性最高（5 - 5.9%）。体重而非身高或年龄有显著影响。IC的ES 95%预测区间为27至46毫米（16 - 23毫米/平方米），AP为22至36毫米（13 - 18毫米/平方米）（p<0.001）。相应的体重校正区间为0.39至0.59（IC）和0.32至0.48（AP）毫米/千克。没有受试者的IC:AP<1.1且AP>0.45毫米/千克。
在ES、MO和ED进行的测量中，ES时的测量结果可重复性最高，且在正常、非肥胖受试者中可获得高质量图像。这些距离应结合体重或体表面积以及彼此之间进行判断。最大的IC距离和最椭圆的形状出现在ES时，而二尖瓣环在ED时最小。所呈现的程序和正常范围可能有助于二尖瓣反流患者的评估。
