实时三维超声心动图对正常二尖瓣-左心室复合体的功能解剖

Functional anatomy of normal mitral valve-left ventricular complex by real-time, three-dimensional echocardiography.

作者信息

Kalyanasundaram Arun, Qureshi Anwer, Nassef Louis A, Shirani Jamshid

机构信息

Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA 17822-2160, USA.

出版信息

J Heart Valve Dis. 2010 Jan;19(1):28-34.

PMID:20329487

Abstract

BACKGROUND AND AIM OF THE STUDY

A detailed anatomic examination of the mitral valve (MV)-left ventricular (LV) complex (annulus, leaflets, chordae, papillary muscles, and ventricular wall) is needed for the accurate assessment of functional mitral regurgitation, and for planning patient-specific valve repair. In the past, normal values for the various components of the MV-LV complex have been derived from two-dimensional echocardiography (2DE), but such measurements require unconventional image planes and allow no off-line adjustments. In addition, measurement of the LV volumes and dimensions of irregular structures (mitral annulus) is more accurate by using three-dimensional echocardiography (3DE). The study aim was to assess, quantitatively, the MV-LV complex by real-time 3DE in normal adults.

METHODS

The components of the MV-LV complex were measured off-line at mid-diastole (anterior MV leaflet), end-diastole and end-systole, after full volume real-time 3DE data sets had been obtained using a matrix transducer in 10 normal adults (six females, four males; mean age 25 +/- 5 years; range: 18-35 years; mean body surface area 1.8 +/- 0.2 m2). 2DE measurements were made for comparison.

RESULTS

The 2DE measurements were systematically smaller (1-12%) than 3DE measurements, due to a foreshortening of the various components of the MV-LV complex during 2DE imaging. By 3DE imaging, MV competence in normal hearts was achieved by systolic reduction in the LV volume (58%), LV length (17%), inter-papillary muscle distance (39%), annular diameter (6% anteroposterior, 14% mediolateral), and the length of both papillary muscles (21-31%). At end-systole, the anterior MV leaflet was 20% shorter (2.5 +/- 0.3 versus 2.0 +/- 0.3 cm), due to folding at the coaptation point.

CONCLUSION

These data provide normal real-time 3DE reference values for the MV-LV complex. 3DE appears superior to 2DE for accurate functional assessment of the MV-LV complex.

摘要

研究背景与目的

为准确评估功能性二尖瓣反流以及制定针对患者的瓣膜修复方案，需要对二尖瓣（MV）-左心室（LV）复合体（瓣环、瓣叶、腱索、乳头肌和心室壁）进行详细的解剖学检查。过去，MV-LV复合体各组成部分的正常值来自二维超声心动图（2DE），但此类测量需要非常规的图像平面，且不允许进行离线调整。此外，使用三维超声心动图（3DE）测量左心室容积和不规则结构（二尖瓣环）的尺寸更为准确。本研究的目的是通过实时3DE对正常成年人的MV-LV复合体进行定量评估。

方法

使用矩阵换能器对10名正常成年人（6名女性，4名男性；平均年龄25±5岁；范围：18 - 35岁；平均体表面积1.8±0.2 m²）获取全容积实时3DE数据集后，在舒张中期（前叶MV）、舒张末期和收缩末期离线测量MV-LV复合体的各组成部分。进行2DE测量以作比较。

结果

由于在2DE成像过程中MV-LV复合体各组成部分的缩短，2DE测量值系统地比3DE测量值小（1 - 12%）。通过3DE成像，正常心脏中的MV功能通过左心室容积收缩（58%）、左心室长度收缩（17%）、乳头肌间距离收缩（39%）、瓣环直径收缩（前后径6%，中外径14%）以及两个乳头肌长度收缩（21 - 31%）得以实现。在收缩末期，前叶MV缩短20%（2.5±0.3对2.0±0.3 cm），这是由于在贴合点处折叠所致。