二尖瓣修复术前和术后应用二维和三维经食管超声心动图评估二尖瓣瓣叶对合区。
Assessment of the mitral valve coaptation zone with 2D and 3D transesophageal echocardiography before and after mitral valve repair.
作者信息
Guo Yong, He Yihua, Zhang Ye, Ge Shuping, Sun Lin, Liu Wenxu, Han Jiancheng, Gu Xiaoyan
机构信息
Department of Ultrasound, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China.
St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
出版信息
J Thorac Dis. 2018 Jan;10(1):283-290. doi: 10.21037/jtd.2017.12.62.
BACKGROUND
Mitral valve (MV) coaptation is very important in MV repair patients. But accurate quantitation of the degree of MV coaptation remains challenging. This study aimed to evaluate the utility of two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) to assess MV coaptation before and after MV repair.
METHODS
Forty-eight patients [(age: 52.23±13.31 years; 26 men (54.17%)] undergoing MV repair for mitral regurgitation (MR) were studied. We assessed the utility of 2D and 3D TEE to assess MV coaptation before and after MV repair. Complete conventional 2D and 3D TEE studies were performed, and the degree of the MV coaptation defect before and after surgery was assessed by measuring the MV coaptation length (CL) and length index (CLI) with 2D TEE, and the coaptation area (CA) and coaptation area index (CAI) with 3D TEE.
RESULTS
CL and CLI were measured successfully in 46 (95.83%) patients and CA and CAI in 39 (81.25%). Compared with preoperatively, postoperative CL, CLI, CA, and CAI were significantly increased (CL: 4.99±0.79 to 9.66±1.09 mm, P<0.05; CLI: 9.30%±2.66% to 38.24%±3.82%, P<0.05; CA: 158.49±64.17 to 371.33±143.57 mm, P<0.05; CAI: 9.71%±2.76% to 36.24%±7.26%, P<0.05). Spearman's rank correlation analysis revealed that the CLI and CAI had a significant negative correlation with the degree of MR (r=-0.97, P<0.01; r=-0.92, P<0.01, respectively). Furthermore, Pearson's correlation analysis revealed that the CLI was significantly correlated with the CAI both preoperatively (r=-0.66, P<0.01) and postoperatively (r=-0.67, P<0.01).
CONCLUSIONS
The coaptation variables increased significantly in patients undergoing MV repair. The CLI and CAI significantly correlated with MR severity. The CL and CLI determined with 2D TEE are more feasible than the CA and CAI determined with 3D TEE. Both 2D and 3D variables may complement each other for aiding MV repair. 2D CLI is an alternative to 3D CAI due to its simplicity.
背景
二尖瓣（MV）对合在二尖瓣修复患者中非常重要。但准确量化二尖瓣对合程度仍具有挑战性。本研究旨在评估二维（2D）和三维（3D）经食管超声心动图（TEE）在二尖瓣修复前后评估二尖瓣对合情况的效用。
方法
对48例因二尖瓣反流（MR）接受二尖瓣修复的患者[年龄：52.23±13.31岁；26例男性（54.17%）]进行研究。我们评估了2D和3D TEE在二尖瓣修复前后评估二尖瓣对合情况的效用。进行了完整的传统2D和3D TEE检查，并通过2D TEE测量二尖瓣对合长度（CL）和长度指数（CLI），以及通过3D TEE测量对合面积（CA）和对合面积指数（CAI），来评估手术前后二尖瓣对合缺陷的程度。
结果
46例（95.83%）患者成功测量了CL和CLI，39例（81.25%）患者成功测量了CA和CAI。与术前相比，术后CL、CLI、CA和CAI均显著增加（CL：4.99±0.79至9.66±1.09 mm，P<0.05；CLI：9.30%±2.66%至38.24%±3.82%，P<0.05；CA：158.49±64.17至371.33±143.57 mm，P<0.05；CAI：9.71%±2.76%至36.24%±7.26%，P<0.05）。Spearman等级相关分析显示，CLI和CAI与MR程度呈显著负相关（分别为r=-0.97，P<0.01；r=-0.92，P<0.01）。此外，Pearson相关分析显示，术前（r=-0.66，P<0.01）和术后（r=-0.67，P<0.01）CLI与CAI均显著相关。
结论
二尖瓣修复患者的对合变量显著增加。CLI和CAI与MR严重程度显著相关。2D TEE测定的CL和CLI比3D TEE测定的CA和CAI更可行。2D和3D变量可相互补充以辅助二尖瓣修复。由于其简单性，2D CLI可替代3D CAI。
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