三维超声心动图分析三尖瓣环提供了三尖瓣解剖和功能的新视角。
3-Dimensional Echocardiographic Analysis of the Tricuspid Annulus Provides New Insights Into Tricuspid Valve Geometry and Dynamics.
机构信息
Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
出版信息
JACC Cardiovasc Imaging. 2019 Mar;12(3):401-412. doi: 10.1016/j.jcmg.2017.08.022. Epub 2017 Nov 15.
OBJECTIVES
The authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers.
BACKGROUND
Accurate sizing of the TA is essential for planning tricuspid annuloplasty and for implantation of new percutaneous tricuspid devices.
METHODS
3DE of the TA from 209 healthy volunteers was analyzed using custom software to measure TA area, perimeter, circularity, and dimensions at end diastole (equals tricuspid valve closure), mid-systole, end systole, and late diastole. TA intercommissural distances were measured at mid-systole. For comparison, TA diameters were measured at the same time points on multiplanar reconstruction of the 3DE datasets and on 2-dimensional transthoracic echocardiography (2DE) apical 4-chamber and right ventricular focused views. In 13 subjects with both 3DE and computed tomography, TA parameters were compared.
RESULTS
3DE TA area, perimeter, and dimensions were largest in late diastole and smallest at mid-systole/end systole. Normal tricuspid valve parameters in end diastole were 8.6 ± 2.0 cm for area; 10.5 ± 1.2 cm for perimeter; 36 ± 4 mm and 30 ± 4 mm for longest and shortest dimensions, respectively; and 0.83 ± 0.10 for circularity. There were no age-related changes in TA parameters. Women had larger indexed TA perimeter and longer long-axis dimensions compared with men. The longest 3DE TA dimension was significantly longer than diameters measured from both 2DE and 3D multiplanar reconstruction. 3DE TA area, perimeter, and dimensions correlated with both right atrial and right ventricular volumes, suggesting that both chambers may be determinants of TA size. TA fractional area change was 35 ± 10%. Fractional changes in both perimeter and dimensions were ≥20%. When compared with computed tomography, 3DE systematically underestimated TA parameters.
CONCLUSIONS
Gender and body size should be taken into account to identify the reference values of TA dimensions. 2DE underestimates TA dimensions.
目的
作者使用经胸 3 维经胸超声心动图（3DE）来描述健康志愿者的三尖瓣环（TA）的几何形状和动力学。
背景
准确测量 TA 的大小对于计划三尖瓣环成形术和植入新的经皮三尖瓣装置至关重要。
方法
使用定制软件分析 209 名健康志愿者的 TA 的 3DE，以测量 TA 的面积、周长、圆度以及舒张末期（等于三尖瓣关闭）、收缩中期、收缩末期和舒张晚期的尺寸。在收缩中期测量 TA 的瓣环间距离。为了比较，在 3DE 数据集的多平面重建以及二维经胸超声心动图（2DE）的 apical 4 腔和右心室焦点视图上，同时测量了 TA 的直径。在 13 名同时具有 3DE 和计算机断层扫描的受试者中，比较了 TA 参数。
结果
3DE TA 的面积、周长和尺寸在舒张晚期最大，在收缩中期/收缩末期最小。舒张末期正常三尖瓣参数为：面积 8.6 ± 2.0 cm；周长 10.5 ± 1.2 cm；最长和最短直径分别为 36 ± 4 mm 和 30 ± 4 mm；圆度 0.83 ± 0.10。TA 参数与年龄无关。女性的 TA 周长指数和长轴尺寸大于男性。最长的 3DE TA 尺寸明显长于从 2DE 和 3D 多平面重建测量的直径。3DE TA 的面积、周长和尺寸与右心房和右心室容积相关，表明两个心室可能是 TA 大小的决定因素。TA 的分数面积变化为 35 ± 10%。周长和尺寸的分数变化均≥20%。与计算机断层扫描相比，3DE 系统地低估了 TA 参数。
结论
性别和体型应考虑在内，以确定 TA 尺寸的参考值。2DE 低估了 TA 的尺寸。
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