Gripari Paola, Mapelli Massimo, Bellacosa Ilaria, Piazzese Concetta, Milo Maria, Fusini Laura, Muratori Manuela, Ali Sarah Ghulam, Tamborini Gloria, Pepi Mauro
Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy.
Int J Cardiovasc Imaging. 2018 Jul;34(7):1099-1107. doi: 10.1007/s10554-018-1324-2. Epub 2018 Feb 26.
Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a) to evaluate the feasibility and time required for real-time 3D TTE in a large consecutive cohort of patients with severe DMR in the assessment of MV anatomy; (b) to compare the accuracy of 3D TTE and 2D TOE versus surgical inspection in the recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colourDoppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete 3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4 min), with good (49%) and optimal (33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93 and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse (99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3D TTE, albeit it determined a better sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the pathology as accurate as the 2D TOE.
退行性二尖瓣反流（DMR）的二尖瓣（MV）修复成功主要与手术专业技能和MV解剖结构有关。尽管二维超声心动图，特别是经食管超声心动图（TOE），可提供有关MV解剖结构的精确信息，但矩阵技术的最新进展意味着向前迈出了决定性的一步，即可以通过无创三维经胸超声心动图（TTE）方法准确地进行节段性MV分析。本研究的目的是：（a）评估在一大组连续的重度DMR患者中，实时三维TTE评估MV解剖结构的可行性和所需时间；（b）比较三维TTE和二维TOE与手术检查在识别和定位MV瓣叶所有组成部分方面的准确性；（c）确定三维彩色多普勒检查相对于单纯三维形态学评估的附加诊断价值。149例连续的重度DMR患者在手术前接受了完整的三维TTE检查，并在手术室接受了二维TOE检查。将通过不同技术获得的超声心动图数据与手术检查结果进行比较。三维TTE在相对较短的时间内（8±4分钟）是可行的，大多数病例的成像质量良好（49%）和最佳（33%）。与二维TOE相比，三维TTE的总体准确性显著更高（分别为93%和91%，p<0.05）。在识别A3脱垂方面，二维TOE比三维TTE显著更具特异性（99%对96%）。彩色多普勒模式虽未显著提高三维TTE的准确性，但与二维TOE相比，在检测A2脱垂方面具有更高的敏感性（95%对85%）。有或没有彩色多普勒的三维TTE是分析MV脱垂的一种可行且有用的方法；它能够对病变进行术前无创描述，其准确性与二维TOE相当。
