Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
J Am Soc Echocardiogr. 2012 Jul;25(7):758-65. doi: 10.1016/j.echo.2012.03.010. Epub 2012 Apr 24.
Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than two-dimensional (2D) TEE in the qualitative assessment of mitral valve (MV) prolapse (MVP). However, the accuracy of 3D TEE in quantifying MV anatomy is less well studied, and its clinical relevance for MV repair is unknown.
The number of prolapsed segments, leaflet heights, and annular dimensions were assessed using 2D and 3D TEE and compared with surgical measurements in 50 patients (mean age, 61 ± 11 years) who underwent MV repair for mainly advanced MVP.
Three-dimensional TEE was more accurate (92%-100%) than 2D TEE (80%-96%) in identifying prolapsed segments. Three-dimensional TEE and intraoperative measurements of leaflet height did not differ significantly, while 2D TEE significantly overestimated the height of the posterior segment P1 and the anterior segment A2. Three-dimensional TEE quantitative MV measurements were related to surgical technique: patients with more complex MVP (one vs two to four vs five or more prolapsed segments) showed progressive enlargement of annular anteroposterior (31 ± 5 vs 34 ± 4 vs 37 ± 6 mm, respectively, P = .02) and commissural diameters (40 ± 6 vs 44 ± 5 vs 50 ± 10 mm, respectively, P = .04) and needed increasingly complex MV repair with larger annuloplasty bands (60 ± 13 vs 67 ± 9 vs 72 ± 10 mm, P = .02) and more neochordae (7 ± 3 vs 12 ± 5 vs 26 ± 6, P < .01).
Measurements of MV anatomy on 3D TEE are accurate compared with surgical measurements. Quantitative MV characteristics, as assessed by 3D TEE, determined the complexity of MV repair.
三维（3D）经食管超声心动图（TEE）在二尖瓣脱垂（MVP）的定性评估中比二维（2D）TEE 更准确。然而，3D TEE 定量评估 MV 解剖结构的准确性研究较少，其对 MV 修复的临床意义尚不清楚。
对 50 例（平均年龄 61±11 岁）因主要为晚期 MVP 而行 MV 修复的患者，使用 2D 和 3D TEE 评估脱垂节段数量、瓣叶高度和瓣环尺寸，并与手术测量值进行比较。
3D TEE 比 2D TEE（80%-96%）更准确（92%-100%）地识别脱垂节段。3D TEE 和术中测量的瓣叶高度无显著差异，而 2D TEE 显著高估了后叶 P1 和前叶 A2 的高度。3D TEE 的 MV 定量测量值与手术技术有关：更复杂 MVP（1 个 vs 2-4 个 vs 5 个或更多脱垂节段）患者的瓣环前后径（31±5 vs 34±4 vs 37±6mm，P=0.02）和交界径（40±6 vs 44±5 vs 50±10mm，P=0.04）逐渐增大，需要用更大的瓣环成形环（60±13 vs 67±9 vs 72±10mm，P=0.02）和更多的人工腱索（7±3 vs 12±5 vs 26±6，P<0.01）进行更复杂的 MV 修复。
3D TEE 测量的 MV 解剖结构与手术测量值相比准确。3D TEE 评估的 MV 定量特征决定了 MV 修复的复杂性。
