Cardiology Department, Columbia University Medical Center, New York, New York 10032, USA.
JACC Cardiovasc Imaging. 2012 Jul;5(7):669-76. doi: 10.1016/j.jcmg.2012.03.008.
The aim of this study was to determine whether direct measurement of multiple-jet vena contracta (VC) areas by real-time 3-dimensional (3D) transesophageal echocardiography is an accurate method for measuring the severity of mitral regurgitation (MR) in patients with multiple MR jets.
Because of the conflicting requirements of Doppler and imaging physics, measuring VC using 2-dimensional (2D) echocardiography is a difficult procedure for assessing MR severity. A real-time 3D echocardiographic measurement of the VC area has been validated in a single jet of MR, but the applicability of this method for multiple jets is unknown.
Two-dimensional and 3D transesophageal echocardiography was performed in 60 patients with multiple functional MR jets. MR severity was assessed quantitatively using the effective regurgitant orifice area derived from 3D left ventricular volume and thermodilution data (EROAstd). Manual tracings of multiple 3D VC areas in a cross-sectional plane through the VC were obtained, and the sum of the areas was compared using EROAstd. Similarly, 2D measurement of VC diameter was obtained from a 2D transesophageal echocardiographic view to optimize the largest legion size in each jet. All VC diameters were summed and compared with EROAstd.
The correlation of the sum of the multiple 3D VC areas with EROAstd (r = 0.90, p < 0.01) was higher than that of the sum of the multiple 2D VC diameters (r = 0.56, p < 0.01), particularly with MR degrees greater than mild (r = 0.80, p < 0.01 vs. r = 0.05, p = 0.81) and in cases of 3 or more regurgitant jets (r = 0.91, p < 0.01 vs. r = 0.46, p = 0.05).
Direct measurement of multiple VC areas using 3D transesophageal echocardiography allows for assessing MR severity in patients with multiple jets, particularly for MR degrees greater than mild and in cases of more than 2 jets, for which geometric assumptions may be challenging.
本研究旨在确定实时三维（3D）经食管超声心动图直接测量多射流瓣口收缩期最小截面（VC）面积是否为评估多瓣反流射流患者二尖瓣反流（MR）严重程度的准确方法。
由于多普勒和成像物理的要求相互冲突，使用二维（2D）超声心动图测量 VC 是评估 MR 严重程度的一项困难操作。已在单一 MR 射流中验证了 VC 面积的实时 3D 超声心动图测量，但该方法对多射流的适用性尚不清楚。
对 60 例存在多瓣功能性 MR 射流的患者进行二维和 3D 经食管超声心动图检查。使用 3D 左心室容积和热稀释数据（EROAstd）导出的有效反流口面积对 MR 严重程度进行定量评估。在 VC 的横断面上获得多个 3D VC 面积的手动描记，并将面积之和与 EROAstd 进行比较。同样，从 2D 经食管超声心动图视图中获取 VC 直径的 2D 测量值，以优化每个射流中的最大线段尺寸。将所有 VC 直径相加并与 EROAstd 进行比较。
多个 3D VC 面积之和与 EROAstd 的相关性（r = 0.90，p < 0.01）高于多个 2D VC 直径之和（r = 0.56，p < 0.01），尤其是在 MR 程度大于轻度（r = 0.80，p < 0.01 与 r = 0.05，p = 0.81）和存在 3 个或更多反流射流（r = 0.91，p < 0.01 与 r = 0.46，p = 0.05）的情况下。
使用 3D 经食管超声心动图直接测量多个 VC 面积可用于评估存在多射流的患者的 MR 严重程度，特别是对于 MR 程度大于轻度和存在 2 个以上射流的情况，对于这些情况，几何假设可能具有挑战性。
