Sugeng Lissa, Spencer Kirk T, Mor-Avi Victor, DeCara Jeanne M, Bednarz James E, Weinert Lynn, Korcarz Claudia E, Lammertin Georgeanne, Balasia Beth, Jayakar David, Jeevanandam Valluvan, Lang Roberto M
Department of Medicine, Section of Cardiology, University of Chicago Medical Center, IL, USA.
Echocardiography. 2003 Apr;20(3):265-73. doi: 10.1046/j.1540-8175.2003.03024.x.
Prior studies have reconstructed mitral regurgitant flow in three dimensions displaying gray scale renditions of the jets, which were difficult to differentiate from surrounding cardiac structures. Recently, a color-coded display of three-dimensional (3D) regurgitant flow has been developed. However, this display was unable to integrate cardiac anatomy, thereby losing spatial information, which made it difficult to determine the jet origin and its spatial trajectory. To overcome this limitation, an improved method of 3D color reconstruction of regurgitant jets obtained from color flow Doppler using a transesophageal approach was developed to allow the combined display of both color flow and gray scale information.
To demonstrate the feasibility of 3D reconstruction of regurgitant mitral flow jets using an improved method of color encoding digital data acquired by transesophageal echocardiography (TEE).
We studied 46 patients undergoing a clinically indicated TEE study. All subjects had mitral regurgitation detected on a previous transthoracic study. Atrial fibrillation or poor image quality were not used as exclusion criteria. The 3D study was performed using a commercial ultrasound imaging system with a TEE probe (Sonos 5500, Agilent Technologies). A rotational mode of acquisition was used to collect two-dimensional (2D) color flow images at 3-degree intervals over 180 degrees. Images were processed off line using the Echo-View Software (TomTec Imaging Systems). Volume-rendered 3D color flow jets were displayed along with gray scale information of the adjacent cardiac structures.
Mitral regurgitant flow, displayed in left atrial and two longitudinal orientations, was successfully reconstructed in all patients. The time for acquisition, post-processing, and rendering ranged between 10 and 15 minutes. There were 28 centrally directed jets and 15 eccentric lesions. Eight patients in the study had periprosthetic mitral regurgitant flow.
Three-dimensional imaging of mitral regurgitant jets is feasible in the majority of patients. This improved technique provides additional information to that obtained from the 2D examination. Particularly, in patients with paravalvular leaks 3D color flow Doppler provides information on the origin and the extent of the dehiscence, as well as insight into the jet direction. In addition, in patients with eccentric mitral regurgitation, this new modality overcomes the inherent limitations of 2D echo Doppler by depicting the full extent of the jet trajectory.
既往研究已对二尖瓣反流进行三维重建，显示出射流的灰阶图像，但这些图像很难与周围心脏结构区分开来。最近，已开发出一种三维（3D）反流彩色编码显示方法。然而，这种显示方法无法整合心脏解剖结构，从而丢失了空间信息，这使得确定射流起源及其空间轨迹变得困难。为克服这一局限性，开发了一种改进的方法，用于对经食管途径获取的彩色多普勒反流射流进行三维彩色重建，以实现彩色血流和灰阶信息的联合显示。
利用一种改进的彩色编码方法对经食管超声心动图（TEE）获取的数字数据进行三维重建，以证明二尖瓣反流射流三维重建的可行性。
我们对46例接受临床指征TEE检查的患者进行了研究。所有受试者在之前的经胸检查中均检测到二尖瓣反流。房颤或图像质量差不作为排除标准。使用配备TEE探头的商用超声成像系统（Sonos 5500，安捷伦科技公司）进行三维研究。采用旋转采集模式，以3度间隔在180度范围内采集二维（2D）彩色血流图像。使用Echo-View软件（TomTec成像系统）对图像进行离线处理。将容积再现的三维彩色血流射流与相邻心脏结构的灰阶信息一起显示。
所有患者均成功重建了左心房和两个纵向方向显示的二尖瓣反流。采集、后处理和渲染时间在10至15分钟之间。有28例中心性射流和15例偏心性病变。研究中的8例患者存在人工瓣膜二尖瓣反流。
二尖瓣反流射流的三维成像在大多数患者中是可行的。这种改进技术提供了比二维检查更多的信息。特别是，对于瓣周漏患者，三维彩色多普勒提供了关于瓣周裂开起源和范围的信息，以及对射流方向的深入了解。此外，对于偏心性二尖瓣反流患者，这种新方法通过描绘射流轨迹的全貌克服了二维超声多普勒的固有局限性。
