Rönnerfalk Mattias, Tamás Éva
Department of Clinical Physiology, University of Linköping, Linköping, Sweden Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden.
Interact Cardiovasc Thorac Surg. 2015 Jul;21(1):71-6. doi: 10.1093/icvts/ivv072. Epub 2015 Apr 2.
The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and characteristics of the purely regurgitant aortic valve in detail.
Twenty-nine men, with chronic aortic regurgitation without concomitant heart disease referred for aortic valve intervention, underwent 2D transoesophageal echocardiographic (TEE) examination prior to surgery according to a previously published matrix. Measurements of the aortic valve apparatus in long and short axis view were made in systole and diastole and analysed off-line. The aortic valves were grouped as tricuspid (TAV) or bicuspid (BAV), and classified by regurgitation mechanism.
Twenty-four examinations were eligible for analysis of which 13 presented TAV and 11 BAV. The regurgitation mechanism was classified as dilatation of the aorta in 6 cases, as prolapse in 11 cases and as poor cusp tissue quality or quantity in 7 cases. The ventriculo-aortic junction (VAJ) and valve opening were closely related (TAV r = 0.5, BAV r = 0.73) but no correlation was found between the VAJ and the maximal sinus diameter (maxSiD) or the sinotubular junction (STJ). However, the STJ and maxSiD were significantly related (TAV vs BAV: systole r = 0.9, r = 0.8; diastole r = 0.9, r = 0.7), forming an entity. The conjoined BAV cusps were shorter than the anterior cusps when closed (P = 0.002); the inter-commissural distances of the cusps in the BAV group were significantly different (P = 0.001 resp. 0.03) in both systole and diastole.
The VAJ was independent of other aortic dimensions and should thereby be considered as a separate entity with influence on valve opening. The detailed 2D TEE measurements of this study add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root either as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This may have an impact on decisions regarding repairability of the native aortic valve.
主动脉瓣疾病新出现的治疗选择需要更精密的诊断方法。我们旨在详细描述单纯反流性主动脉瓣的超声心动图病理生理学及特征。
29名患有慢性主动脉瓣反流且无合并心脏病、因主动脉瓣干预前来就诊的男性，在手术前根据先前发表的矩阵接受了二维经食管超声心动图（TEE）检查。在收缩期和舒张期对主动脉瓣装置进行长轴和短轴视图测量，并进行离线分析。将主动脉瓣分为三尖瓣（TAV）或二叶瓣（BAV），并按反流机制分类。
24项检查符合分析条件，其中13项为TAV，11项为BAV。反流机制分类为：主动脉扩张6例，脱垂11例，瓣叶组织质量或数量不佳7例。心室-主动脉连接（VAJ）与瓣膜开放密切相关（TAV中r = 0.5，BAV中r = 0.73），但未发现VAJ与最大窦直径（maxSiD）或窦管交界（STJ）之间存在相关性。然而，STJ与maxSiD显著相关（TAV与BAV比较：收缩期r = 0.9，r = 0.8；舒张期r = 0.9，r = 0.7），形成一个整体。BAV联合瓣叶在关闭时比前瓣叶短（P = 0.002）；BAV组瓣叶在收缩期和舒张期的瓣叶间距离均有显著差异（分别为P = 0.001和0.03）。
VAJ独立于其他主动脉尺寸，因此应被视为一个对瓣膜开放有影响的单独实体。本研究详细的二维TEE测量为我们关于病理性主动脉瓣及根部的功能和超声心动图解剖的知识增添了更多重要信息，无论是作为独立检查还是作为三维超声心动图的基准和补充。这可能会对关于天然主动脉瓣可修复性的决策产生影响。
