Yeong Michael, Silbery Marcus, Finucane Kirsten, Wilson Nigel J, Gentles Thomas L
Boston Children's Hospital, Boston, USA,
Pediatr Cardiol. 2015 Apr;36(4):827-34. doi: 10.1007/s00246-014-1085-1. Epub 2015 Jan 6.
Rheumatic mitral valve disease is associated with valvulitis and valvular regurgitation; however, the effect of the rheumatic process on the mitral valve geometry and function is not well understood. To assess mitral valve annulus remodelling in rheumatic mitral valve disease, 16 subjects aged 6-15 years with rheumatic mitral valve regurgitation [MR] [6 mild or moderate (Group 1), 10 severe (Group 2)] and 7 age- and body size-matched normal controls with adequate trans-thoracic echocardiograms were recruited. None of the patients had undergone surgical intervention and none had more than mild aortic regurgitation. None of the patients had mitral stenosis. 3D mitral valve geometry was assessed using a Tomtec system. The non-planar angle was increased in all subjects during early (control 147° ± 10, Group 1 168° ± 9, Group 2 166° ± 10; p < 0.05) and late systole (control 149° ± 12, Group 1 162° ± 10, Group 2 164° ± 6; p < 0.05), indicating loss of saddle shape. 2D annular area increased in Group 2 (control 397 ± 48 mm(2)/m(2) vs Group 2 739 ± 207, p < 0.05) with no significant change in annular perimeter indicating leaflet effacement. Mitral valve area correlated with left ventricular size (p < 0.001, r (2) = 0.74). There was no significant change in valve area and perimeter between early and late systole. Remodelling of the mitral valve apparatus in childhood rheumatic heart disease results in abnormal annular geometry. The mitral valve loses its saddle shape regardless of the severity of MR. This may be a consequence of inflammation on the fibrous trigones and surrounding annulus. In contrast, annular area enlargement occurs as a result of leaflet effacement and relates to MR severity and LV size.
风湿性二尖瓣疾病与瓣膜炎和瓣膜反流有关；然而，风湿过程对二尖瓣几何形状和功能的影响尚未完全了解。为了评估风湿性二尖瓣疾病中二尖瓣环重塑情况，招募了16名年龄在6至15岁、患有风湿性二尖瓣反流[MR][6例轻度或中度（第1组），10例重度（第2组）]的受试者以及7名年龄和体型匹配、经胸超声心动图检查结果正常的对照者。所有患者均未接受过手术干预，且均无超过轻度的主动脉反流。所有患者均无二尖瓣狭窄。使用Tomtec系统评估二尖瓣的三维几何形状。在收缩早期（对照组147°±10，第1组168°±9，第2组166°±10；p<0.05）和晚期（对照组149°±12，第1组162°±10，第2组164°±6；p<0.05），所有受试者的非平面角均增大，表明鞍形消失。第2组二维瓣环面积增加（对照组397±48mm²/m²，第2组739±207，p<0.05），瓣环周长无显著变化，提示瓣叶消失。二尖瓣面积与左心室大小相关（p<0.001，r²=0.74）。收缩早期和晚期之间瓣膜面积和周长无显著变化。儿童风湿性心脏病中二尖瓣装置的重塑导致瓣环几何形状异常。无论MR的严重程度如何，二尖瓣均失去其鞍形。这可能是纤维三角和周围瓣环炎症的结果。相比之下，瓣环面积增大是瓣叶消失的结果，与MR严重程度和左心室大小有关。
