Gabriel Latcu Decebal, Paranon Soizic, Bongard Vanina, Bassil-Eter Rania, Grosjean-Guitton Juliette, Dulac Yves, Acar Philippe
Cardiology Department, Princesse Grace Hospital, Monaco.
Arch Cardiovasc Dis. 2008 Nov-Dec;101(11-12):697-703. doi: 10.1016/j.acvd.2008.09.009. Epub 2008 Nov 20.
Evaluation of mitral-regurgitation (MR) severity in infants is challenging. Real-time three-dimensional echocardiography (RT3DE) allows accurate left-ventricular volumetric measurements in adults.
To validate RT3DE by measuring stroke volume in a normal paediatric population, then to use this new method to calculate regurgitant volume in paediatric patients with MR.
Fifty-four patients, aged one week to 19 years, (29 without and 25 with MR) had two-dimensional echocardiography coupled with RT3DE left-ventricular volumetric acquisition. Stroke volume was calculated by the Doppler method at the aortic annulus (SV(D)). End-systolic and end-diastolic left-ventricular volumes were measured using the QLab semi-automated method; three-dimensional stroke volume (SV(3D)) was calculated as their difference. In the MR group, regurgitant volume was calculated by the PISA method (RV(PISA)) and as the difference between SV(3D) and SV(D) (RV(3D)). Regurgitant fraction was also evaluated by these methods (RF(PISA) and RF(3D)).
Measurement feasibility was 88%. In the normal group, SV(3D) (27.9+/-18.1 ml) was highly correlated with SV(D) (30.7+/-19.6 ml; r=0.98; p<0.000). In the MR group, RV(PISA) (15.7+/-14.4 ml) and RV(3D) (11.0+/-10.2 ml) were well correlated (r=0.83; p<0.001). Regurgitant fractions were also well correlated (RF(PISA)=30.4+/-17.0%; RF(3D)=24.3+/-15.9%; r=0.79, p=0.006).
RT3DE is a simple, rapid and reliable method for evaluating stroke volume in children and may, therefore, be useful for evaluating regurgitant volume and fraction in paediatric patients with MR.
评估婴儿二尖瓣反流（MR）的严重程度具有挑战性。实时三维超声心动图（RT3DE）可对成人左心室容积进行准确测量。
通过测量正常儿科人群的每搏输出量来验证RT3DE，然后使用这种新方法计算患有MR的儿科患者的反流容积。
54例年龄在1周至19岁之间的患者（29例无MR，25例有MR）接受了二维超声心动图检查，并进行了RT3DE左心室容积采集。通过主动脉瓣环处的多普勒方法计算每搏输出量（SV(D)）。使用QLab半自动方法测量收缩末期和舒张末期左心室容积；三维每搏输出量（SV(3D)）计算为两者之差。在MR组中，通过PISA方法计算反流容积（RV(PISA)），并将其计算为SV(3D)与SV(D)之差（RV(3D)）。还通过这些方法评估反流分数（RF(PISA)和RF(3D)）。
测量可行性为88%。在正常组中，SV(3D)（27.9±18.1 ml）与SV(D)（30.7±19.6 ml；r = 0.98；p < 0.000）高度相关。在MR组中，RV(PISA)（15.7±14.4 ml）与RV(3D)（11.0±10.2 ml）相关性良好（r = 0.83；p < 0.001）。反流分数也具有良好的相关性（RF(PISA)=30.4±17.0%；RF(3D)=24.3±15.9%；r = 0.79，p = 0.006）。
RT3DE是一种评估儿童每搏输出量的简单、快速且可靠的方法，因此可能有助于评估患有MR的儿科患者的反流容积和分数。
