Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Thorac Surg. 2010 Dec;90(6):1922-9. doi: 10.1016/j.athoracsur.2010.06.116.
Advances in the minimally invasive mitral valve repair techniques increase the demands on accurate and reliable morphologic assessment of the mitral valve using three-dimensional imaging modalities. The present study compared mitral valve geometry measurements obtained by three-dimensional transesophageal echocardiography (TEE) to those obtained with multidetector row computed tomography (MDCT) used as a standard reference.
Clinical preoperative MDCT and intraoperative three-dimensional TEE were performed in 43 patients (mean age 81.0 ± 7.7 years) considered for transcatheter valve implantation procedure. Various measurements of mitral valve geometry were obtained from three-dimensional TEE datasets using mitral valve quantification software, and compared with those obtained from MDCT images using multiplanar reformation planes.
Moderate and severe mitral regurgitation was present in 48.9% of patients. There was good agreement in mitral valve geometry measurements between three-dimensional TEE and MDCT without significant overestimation or underestimation and tight 95% limits of agreement. For linear dimensions, angles and areas, the 95% limits of agreement were less than 1 cm, less than 15 degrees, and less than 2 cm(2), respectively. In addition, the intraclass correlation coefficients were more than 0.8 for all parameters. Finally, the measurements were highly reproducible, with low intraobserver and interobserver variability (nonsignificant overestimation or underestimation and narrow 95% limits of agreement).
The present study demonstrates the accuracy and clinical feasibility of the assessment of the mitral valve geometry with three-dimensional TEE that is comparable to the MDCT measurements. Three-dimensional TEE and MDCT provide accurate and complementary information in the evaluation of patients with mitral valve disease. Its potential incremental clinical value in the field of transcatheter mitral repair procedures needs further assessment in the future studies.
微创二尖瓣修复技术的进步增加了对使用三维成像模式对二尖瓣进行准确可靠形态评估的需求。本研究比较了三维经食管超声心动图（TEE）获得的二尖瓣几何测量值与作为标准参考的多排 CT（MDCT）获得的测量值。
对 43 例（平均年龄 81.0±7.7 岁）接受经导管瓣膜植入术的患者进行术前临床 MDCT 和术中三维 TEE。使用二尖瓣定量软件从三维 TEE 数据集获得各种二尖瓣几何测量值，并与使用多平面重建平面从 MDCT 图像获得的测量值进行比较。
48.9%的患者存在中度和重度二尖瓣反流。三维 TEE 和 MDCT 之间的二尖瓣几何测量值具有良好的一致性，没有明显的高估或低估以及紧密的 95%一致性界限。对于线性尺寸、角度和面积，95%的一致性界限分别小于 1cm、小于 15 度和小于 2cm2。此外，所有参数的组内相关系数均大于 0.8。最后，测量结果高度可重现，观察者内和观察者间变异性低（无显著高估或低估以及狭窄的 95%一致性界限）。
本研究表明，三维 TEE 评估二尖瓣几何形状的准确性和临床可行性可与 MDCT 测量值相媲美。三维 TEE 和 MDCT 在评估二尖瓣疾病患者方面提供了准确和互补的信息。其在经导管二尖瓣修复术领域的潜在临床增量价值需要在未来的研究中进一步评估。
