二尖瓣脱垂成形术前、后二尖瓣装置的定量分析：三维术中经食管研究。
Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty: a three-dimensional intraoperative transesophageal study.
机构信息
Department of Biomedical Engineering, Politecnico di Milano, Milan, Italy.
出版信息
J Am Soc Echocardiogr. 2011 Apr;24(4):405-13. doi: 10.1016/j.echo.2011.01.012. Epub 2011 Feb 24.
BACKGROUND
Intraoperative real-time three-dimensional transesophageal echocardiography has been shown useful in the evaluation of the mitral valve (MV) apparatus, and dedicated commercial software allows its quantitative assessment. The aims of this study were to (1) quantify the effects induced by prolapse on MV anatomy in the presence of fibroelastic deficiency (FED) or Barlow's disease (BD), (2) assess the effect of surgery on the MV apparatus, and (3) investigate the potential role of three-dimensional transesophageal echocardiography in surgical planning.
METHODS
Fifty-six patients (29 with FED, 27 with BD) undergoing MV repair and annuloplasty were studied immediately before and after surgery. Also, 18 age-matched patients with normal MV anatomy, undergoing coronary artery bypass, were included as a control group. Three-dimensional transesophageal echocardiographic data sets were acquired and analyzed to quantify several MV annulus and leaflet parameters using dedicated software.
RESULTS
MV prolapse and regurgitation were associated with a markedly enlarged annulus (area, 12.0 ± 3.2 cm(2) in FED and 15.4 ± 3.8 cm(2) in BD) and leaflets compared with controls (area, 7.5 ± 2.1 cm(2)), while annular height (4.5 ± 1.3 mm in controls, 4.0 ± 1.3 mm in FED, 5.3 ± 1.6 mm in BD) and the mitral aortic angle (136 ± 12° in controls, 141 ± 12° in FED, 137 ± 11° in BD) were similar. Patients with BD showed greater values than those with FED. MV repair and annuloplasty led to a significant undersizing of leaflet and annular areas (4.0 ± 1.1 cm(2) in FED, 4.9 ± 1.3 cm(2) in BD), diameters, and height (2.6 ± 1.1 mm in FED, 3.4 ± 1.4 mm in BD) compared with controls. Coaptation length remained in the normal range (30 ± 5 mm in controls, 24 ± 6 mm in FED, 28 ± 6 mm in BD). Differences between BD and FED were reduced but still present after surgery.
CONCLUSIONS
Intraoperative three-dimensional transesophageal echocardiography allows quantitative evaluation of the MV apparatus in the presence of FED or BD and could be useful for immediate assessment of the surgical procedure.
背景
术中实时三维经食管超声心动图已被证明可用于评估二尖瓣（MV）装置，并且专用商业软件允许对其进行定量评估。本研究的目的是：（1）量化在存在纤维弹性缺失（FED）或巴洛氏病（BD）的情况下脱垂对 MV 解剖结构的影响；（2）评估手术对 MV 装置的影响；（3）研究三维经食管超声心动图在手术计划中的潜在作用。
方法
56 例接受 MV 修复和瓣环成形术的患者（29 例 FED，27 例 BD）在术前和术后立即进行研究。此外，还纳入了 18 例年龄匹配的 MV 解剖结构正常、接受冠状动脉旁路移植术的患者作为对照组。使用专用软件获取和分析三维经食管超声心动图数据集，以量化几个 MV 瓣环和瓣叶参数。
结果
MV 脱垂和反流与明显增大的瓣环（面积，FED 为 12.0 ± 3.2 cm2，BD 为 15.4 ± 3.8 cm2）和瓣叶有关，与对照组（面积，7.5 ± 2.1 cm2）相比，而瓣环高度（对照组 4.5 ± 1.3 mm，FED 为 4.0 ± 1.3 mm，BD 为 5.3 ± 1.6 mm）和二尖瓣主动脉角（对照组 136 ± 12°，FED 为 141 ± 12°，BD 为 137 ± 11°）相似。BD 患者的数值大于 FED 患者。MV 修复和瓣环成形术导致瓣叶和瓣环面积（FED 为 4.0 ± 1.1 cm2，BD 为 4.9 ± 1.3 cm2）、直径和高度（FED 为 2.6 ± 1.1 mm，BD 为 3.4 ± 1.4 mm）与对照组相比显著缩小。交界长度仍保持在正常范围（对照组 30 ± 5 mm，FED 为 24 ± 6 mm，BD 为 28 ± 6 mm）。手术后，BD 和 FED 之间的差异虽然减少，但仍存在。
结论
术中三维经食管超声心动图可定量评估 FED 或 BD 时的 MV 装置，可用于即时评估手术过程。
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