Deorsola Luca, Bellone Alessandra
Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Turin, Italy.
Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy.
Echocardiography. 2018 Jan;35(1):30-38. doi: 10.1111/echo.13727. Epub 2017 Oct 26.
The Coaptation Triangle, or Tenting Area, can be identified on long-axis 2D images. Its assessment is a routine practice during echocardiographic mitral evaluation. The Golden Proportion is a particular geometric ratio between two segments. Its value is an irrational number, commonly rounded to 0.618 and showing unique geometrical/mathematical properties. Interestingly, its presence has been documented in an extremely variable number of natural settings. Hypothesizing the presence of the Golden Proportion in normal mitral anatomy, we examined the Coaptation Triangle of healthy valves to investigate such a theory.
A total of 41 healthy adults, with normal mitral valves, underwent 2D echocardiography. Adequate images were chosen and loaded into custom software. Firstly, the Coaptation Triangle was manually drawn by the operator. Then, a second Coaptation Triangle, with the same base, but based on Golden Proportion, was automatically built by the software. Eventually, the two triangles were analyzed and compared. All retrieved measurements were investigated for differences and correlations. Ratios close to the Golden Proportion were found in several locations of the manually drawn Coaptation Triangle. On the other hand, comparing the manually drawn Coaptation Triangle with the automatically built one, no significant differences were revealed, and very strong correlations were demonstrated.
The Golden Proportion appears present in the geometry of normal mitral valves. Studying such an aspect and identifying disruption in anatomical proportions could improve early diagnosis of mitral alterations, and allows a more standardized follow-up and help surgeons to plan a repair strategy, particularly quantifying the needed surgical modifications.
在二维长轴图像上可以识别出贴合三角区，即帐篷区。在超声心动图二尖瓣评估过程中，对其进行评估是一项常规操作。黄金比例是两个线段之间的特定几何比率。其值是一个无理数，通常四舍五入为0.618，并具有独特的几何/数学特性。有趣的是，在数量极为多样的自然环境中都有其存在的记录。假设正常二尖瓣解剖结构中存在黄金比例，我们对健康瓣膜的贴合三角区进行了检查，以探究这一理论。
共有41名二尖瓣正常的健康成年人接受了二维超声心动图检查。选择了合适的图像并加载到定制软件中。首先，操作人员手动绘制贴合三角区。然后，软件自动构建一个底边相同但基于黄金比例的第二个贴合三角区。最终，对这两个三角区进行了分析和比较。对所有获取的测量值进行了差异和相关性研究。在手动绘制的贴合三角区的几个位置发现了接近黄金比例的比率。另一方面，将手动绘制的贴合三角区与自动构建的三角区进行比较，未发现显著差异，并显示出非常强的相关性。
黄金比例似乎存在于正常二尖瓣的几何结构中。研究这一方面并识别解剖比例的破坏情况，可能会改善二尖瓣病变的早期诊断，并有助于进行更标准化的随访，帮助外科医生制定修复策略，特别是量化所需的手术修正。
