Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
J Am Soc Echocardiogr. 2014 Jan;27(1):32-41. doi: 10.1016/j.echo.2013.10.007. Epub 2013 Nov 13.
The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery.
In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n = 57) and bicuspid AS (n = 26) and in patients without AS (n = 32). The energy loss coefficient was also measured in patients with AS.
In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%).
Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.
作者假设，二叶式和三叶式主动脉瓣狭窄（AS）的主动脉根部几何形状不同，可通过实时三维（3D）经食管超声心动图来评估。本研究的目的是：（1）验证 3D 经食管超声心动图测量主动脉根部与多排 CT 作为参考的准确性；（2）确定二叶式和三叶式 AS 患者主动脉根部的差异；（3）评估其对压力恢复的影响。
在方案 1 中，对 40 例患者进行 3D 经食管超声心动图和对比增强多排 CT 检查。多平面重建用于测量主动脉瓣环、主动脉窦和窦管交界区的面积，以及从主动脉瓣环到窦管交界区的距离和容积。在方案 2 中，对 57 例三叶式 AS 患者、26 例二叶式 AS 患者和 32 例无 AS 患者进行了相同的 3D 经食管超声心动图测量。还在 AS 患者中测量了能量损失系数。
在方案 1 中，两种方法的主动脉根部几何参数相关性良好。在方案 2 中，与无 AS 患者相比，三叶式 AS 患者的窦管交界区面积和纵向距离较小，导致主动脉根部容积减少 23%。相比之下，二叶式 AS 患者的横截面积和纵向距离较大，导致主动脉根部容积增加 30%。能量损失系数显示，与二叶式 AS 患者（10%）相比，三叶式 AS 患者中有更多的患者从重度 AS 重新分类为中度 AS（17%）。
3D 经食管超声心动图成功地揭示了二叶式和三叶式 AS 之间的不同主动脉根部形态，这对压力恢复有不同的影响。
