Looi Jen-Li, Lee Alex Pui-Wai, Fang Fang, Hsiung Ming C, Sun Jing-Ping, Yin Wei-Hsian, Wei Jeng, Tsai Shen-Kou, Wan Song, Wong Randolph Hl, Underwood Malcolm J, Lin Qing-Shan, Jin Chun-Na, Chen Liu, Yu Cheuk-Man
Division of Cardiology, Department of Medicine and Therapeutics, The Heart Education And Research Training (HEART) Centre, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
Clin Res Cardiol. 2015 Oct;104(10):831-42. doi: 10.1007/s00392-015-0851-2. Epub 2015 Apr 9.
Mitral and aortic valves are coupled via fibrous tissue. This coupling is considered to be important for cardiac function before and after mitral valve surgery. The relationship between mitral-aortic coupling and different types of mitral regurgitation (MR) is not completely understood.
Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) was performed in 133 subjects: 30 normal subjects, 15 patients with Carpentier type I MR (annular dilatation and congenital cleft), 40 type II (mitral valve prolapse), 20 type IIIa (rheumatic) and 28 type IIIb (ischemic mitral regurgitation). Custom software was used to track mitral (MA) and aortic annuli (AoA) in 3D space throughout cardiac cycle, allowing measurement of changes in mitral and aortic valve morphology. Normal mitral-aortic coupling is characterized by reciprocal changes in the annular areas throughout cardiac cycle, with systolic reduction of the angle between the two annular planes. In Carpentier type II patients, not only MA but also AoA areas were increased (P < 0.05 vs normal), but the reciprocal pattern of mitral-aortic coupling was preserved. In both type I IMR and IIIb patients, MA and AoA areas were both increased (P < 0.05 vs normal) and the reciprocal behavior of mitral-aortic coupling was lost. Only MA area was increased in type IIIa patients. The extent of mitral-aortic angle reduction during systole was diminished in all 4 Carpentier groups (P < 0.05 vs normal).
Mitral valve diseases may affect normal mitral-aortic coupling and aortic valve function. Different patterns of abnormal mitral-aortic coupling are associated with different Carpentier types of MR.
二尖瓣和主动脉瓣通过纤维组织相连。这种连接被认为对二尖瓣手术前后的心脏功能很重要。二尖瓣-主动脉瓣连接与不同类型的二尖瓣反流（MR）之间的关系尚未完全明确。
对133名受试者进行了实时三维经食管超声心动图（RT3D-TEE）检查：30名正常受试者，15名患有Carpentier I型MR（瓣环扩张和先天性裂隙）的患者，40名II型（二尖瓣脱垂）患者，20名IIIa型（风湿性）患者和28名IIIb型（缺血性二尖瓣反流）患者。使用定制软件在整个心动周期中跟踪三维空间中的二尖瓣（MA）和主动脉瓣环（AoA），从而测量二尖瓣和主动脉瓣形态的变化。正常的二尖瓣-主动脉瓣连接的特征是在整个心动周期中瓣环面积呈相反变化，两个瓣环平面之间的夹角在收缩期减小。在Carpentier II型患者中，不仅MA而且AoA面积均增加（与正常相比，P <0.05），但二尖瓣-主动脉瓣连接的相反模式得以保留。在I IMR型和IIIb型患者中，MA和AoA面积均增加（与正常相比，P <0.05），并且二尖瓣-主动脉瓣连接的相反行为消失。IIIa型患者仅MA面积增加。在所有4个Carpentier组中，收缩期二尖瓣-主动脉瓣夹角减小的程度均减小（与正常相比，P <0.05）。
二尖瓣疾病可能会影响正常的二尖瓣-主动脉瓣连接和主动脉瓣功能。二尖瓣-主动脉瓣连接异常的不同模式与不同Carpentier类型的MR相关。
