Echocardiography Unit, San Raffaele Scientific Institute, Milan, Italy.
Am J Cardiol. 2011 May 1;107(9):1365-74. doi: 10.1016/j.amjcard.2010.12.048. Epub 2011 Mar 2.
The aim of the study was to evaluate the additional diagnostic value of real-time 3-dimensional transesophageal echocardiography (RT3D-TEE) for surgically recognized mitral valve (MV) prolapse anatomy compared to 2-dimensional transthoracic echocardiography (2D-TTE), 2D-transesophageal echocardiography (2D-TEE), and real-time 3D-transthoracic echocardiography (RT3D-TTE). We preoperatively analyzed 222 consecutive patients undergoing repair for prolapse-related mitral regurgitation using RT3D-TEE, 2D-TEE, RT3D-TTE, and 2D-TTE. Multiplanar reconstruction was added to volume-rendered RT3D-TEE for quantitative prolapse recognition. The echocardiographic data were compared to the surgical findings. Per-patient analysis of RT3D-TEE identified prolapse in 204 patients more accurately (92%) than 2D-TEE (78%), RT3D-TTE (80%), and 2D-TTE (54%). Even among those 60 patients with complex prolapse (>1 segment localization or commissural lesions), RT3D-TEE correctly identified 58 (96.5%) compared to 42 (70%), 31 (52%), and 21 (35%) detected by 2D-TEE, RT3D-TTE, and 2D-TTE (p < 0.0001). Multiplanar reconstruction enabled RT3D-TEE to differentiate dominant (≥5-mm displacement) and secondary (2 to <5-mm displacement) prolapsed segments in agreement with surgically recognized dominant lesions (100%), but with a low predictive value (34%) for secondary lesions. In addition, owing to the identification of clefts and subclefts (indentations of MV tissue that extended ≥50% or <50% of the total leaflet height, respectively), RT3D-TEE accurately characterized the MV anatomy, including that which deviated from the standard nomenclature. In conclusion, RT3D-TEE provided more accurate mapping of MV prolapse than 2D imaging and RT3D-TTE, adding quantitative recognition of dominant and secondary lesions and MV anatomy details.
这项研究的目的是评估实时三维经食管超声心动图（RT3D-TEE）相对于二维经胸超声心动图（2D-TTE）、二维经食管超声心动图（2D-TEE）和实时三维经胸超声心动图（RT3D-TTE）对手术中识别二尖瓣脱垂解剖结构的额外诊断价值。我们术前分析了 222 例连续接受脱垂相关二尖瓣反流修复手术的患者，使用 RT3D-TEE、2D-TEE、RT3D-TTE 和 2D-TTE。对容积渲染 RT3D-TEE 进行多平面重建，以定量识别脱垂。将超声心动图数据与手术结果进行比较。每位患者的 RT3D-TEE 分析比 2D-TEE（78%）、RT3D-TTE（80%）和 2D-TTE（54%）更准确地识别出 204 例患者的脱垂。即使在 60 例具有复杂脱垂（>1 个节段定位或交界病变）的患者中，RT3D-TEE 也正确识别出 58 例（96.5%），而 2D-TEE、RT3D-TTE 和 2D-TTE 分别识别出 42 例（70%）、31 例（52%）和 21 例（35%）（p<0.0001）。多平面重建使 RT3D-TEE 能够区分主导（≥5 毫米移位）和次要（2 至<5 毫米移位）脱垂节段，与手术中识别的主导病变一致（100%），但对次要病变的预测值较低（34%）。此外，由于识别出裂孔和亚裂孔（瓣叶组织的凹陷，分别延伸≥50%或<50%的总瓣叶高度），RT3D-TEE 准确地描述了二尖瓣解剖结构，包括偏离标准命名法的解剖结构。总之，RT3D-TEE 提供了比二维成像和 RT3D-TTE 更准确的二尖瓣脱垂映射，增加了对主导和次要病变以及二尖瓣解剖结构细节的定量识别。
