Pignatelli Ricardo H, Noel Cory, Reddy S Chandra B
aDivision of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas bDivision of Cardiology, Children's Hospital of Los Angeles, Los Angeles, California, USA.
Curr Opin Cardiol. 2017 Sep;32(5):529-540. doi: 10.1097/HCO.0000000000000436.
Pulmonary valve is the least imaged of the cardiac valves in adults. This review will address the strengths and the limitations of various imaging modalities that are commonly used for evaluation of pulmonary valve diseases in the adults.
Valvular pulmonary stenosis is mostly congenital and pulmonary regurgitation is usually an acquired pulmonary valve disease. Combined pulmonary stenosis and pulmonary regurgitation as sequel to previous surgeries for congenital heart diseases is the most common form of pulmonary valve disease in the adults. Transthoracic echocardiography (TTE) is the first-line imaging for the pulmonary valve, however, TTE pose considerable technical limitations in adults secondary to the body habitus, previous surgeries, and imaging artifacts by the interposed foreign tissue. Transesophageal echocardiography is infrequently used because of farther location of the imaging probe from the pulmonary valve precluding optimal imaging. Cardiac computerized tomography (CT) and cardiac MRI are fast emerging as the most preferred imaging modalities for pulmonary valve diseases in the adults.CT is used to obtain precise anatomic information about the pulmonary valve and the contiguous anatomy such as the right ventricular outflow tract, the distal pulmonary arteries including the coronary arteries. MRI by virtue of its high temporal resolution has the unique advantage of obtaining hemodynamic information related to the pulmonary valve; such as quantification of the pulmonary regurgitation, the right ventricle volumes, mass, and the systolic function. Combined imaging with CT and MRI provide anatomic and hemodynamic information in a variety of pulmonary valve diseases; is useful for understanding of the right ventricle adaptive mechanism and remodeling process, for preprocedure planning during percutaneous pulmonary valve implantation and for surveillance of different pulmonary valve diseases.
Multimodality imaging involving a combination of TTE, CT, and (or) MRI are useful to delineate the anatomic and hemodynamic abnormalities associated with different pulmonary valve diseases in the adults.
在成人中，肺动脉瓣是心脏瓣膜中成像最少的。本综述将探讨常用于评估成人肺动脉瓣疾病的各种成像方式的优势和局限性。
瓣膜性肺动脉狭窄大多是先天性的，而肺动脉反流通常是一种后天性肺动脉瓣疾病。先天性心脏病既往手术后继发的肺动脉狭窄合并肺动脉反流是成人肺动脉瓣疾病最常见的形式。经胸超声心动图（TTE）是肺动脉瓣的一线成像方法，然而，由于成人的身体体型、既往手术以及插入的异物组织产生的成像伪影，TTE存在相当大的技术局限性。经食管超声心动图很少使用，因为成像探头离肺动脉瓣较远，无法获得最佳成像。心脏计算机断层扫描（CT）和心脏磁共振成像（MRI）正迅速成为成人肺动脉瓣疾病最首选的成像方式。CT用于获取有关肺动脉瓣以及相邻解剖结构（如右心室流出道、包括冠状动脉在内的远端肺动脉）的精确解剖信息。MRI凭借其高时间分辨率，在获取与肺动脉瓣相关的血流动力学信息方面具有独特优势；例如肺动脉反流的定量、右心室容积、质量和收缩功能。CT和MRI联合成像可在多种肺动脉瓣疾病中提供解剖和血流动力学信息；有助于了解右心室的适应机制和重塑过程，用于经皮肺动脉瓣植入术前规划以及监测不同的肺动脉瓣疾病。
涉及TTE、CT和（或）MRI联合的多模态成像有助于明确成人不同肺动脉瓣疾病相关的解剖和血流动力学异常。
