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二尖瓣狭窄中使用三维经胸超声心动图评估二尖瓣的逐步方案。

Stepwise Protocols for Scoring of Mitral Valve using Three-Dimensional Transthoracic Echocardiography in Mitral Stenosis.

作者信息

Anwar Ashraf M, Attia Wael M

机构信息

Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.

Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

出版信息

J Cardiovasc Echogr. 2019 Jan-Mar;29(1):7-13. doi: 10.4103/jcecho.jcecho_58_18.

DOI:10.4103/jcecho.jcecho_58_18
PMID:31008031
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6450232/
Abstract

AIM

This study aims to propose protocols that enable scoring of mitral valve (MV) in mitral stenosis using the three-dimensional (3D) scoring system.

METHODS

A two-staged study was conducted. The first stage was designed to select the best 3D images of MV leaflets and chordae through analysis of 471 images. The second stage was designed to organize the best 3D images into protocols for complete scoring of MV. It included 35 consecutive patients; 23 had sinus rhythm (SR) and 12 had atrial fibrillation (AF). Both single- and multi-beat 3D acquisition from apical and parasternal windows were focused on MV leaflets and chordae using all 3D modalities (live, zoom, and full volume). To propose the protocols, 1563 images were analyzed.

RESULTS

In SR with good apical window, 2 protocols were recommended for complete scoring of leaflets and chordae (4 zoom 3D images [1 image for leaflets and 3 images for chordae] and 1 full-volume 3D image) using single- and multi-beat acquisition. In AF, the same 2 protocols using single-beat acquisition were recommended. From parasternal window, complete scoring of leaflets was obtained by 3 recommended protocols (single- or multi-beat zoom 3D images from parasternal short axis [PSAX], multibeat live 3D images from PSAX, and single- or multi-beat full-volume 3D images from parasternal long axis) in SR and 1 protocol in AF (single-beat zoom 3D images from PSAX). Scoring of chordae was incomplete in all patients by all 3D modalities.

CONCLUSIONS

The proposed 3D-transthoracic echocardiography protocols suit all patients regardless of echo window and heart rhythm and enabled complete MV scoring.

摘要

目的

本研究旨在提出使用三维（3D）评分系统对二尖瓣狭窄患者的二尖瓣（MV）进行评分的方案。

方法

进行了一项分两阶段的研究。第一阶段旨在通过分析471幅图像来选择二尖瓣叶和腱索的最佳3D图像。第二阶段旨在将最佳3D图像整理成用于二尖瓣完整评分的方案。该阶段纳入了35例连续患者；其中23例为窦性心律（SR），12例为心房颤动（AF）。使用所有3D模式（实时、缩放和全容积），从心尖和胸骨旁窗口进行单搏和多搏3D采集，重点关注二尖瓣叶和腱索。为了提出方案，共分析了1563幅图像。

结果

在心尖窗口良好的窦性心律患者中，推荐2种方案用于二尖瓣叶和腱索的完整评分（4幅缩放3D图像[1幅用于瓣叶，3幅用于腱索]和1幅全容积3D图像），采用单搏和多搏采集。在心房颤动患者中，推荐使用相同的2种单搏采集方案。在窦性心律患者中，通过3种推荐方案（胸骨旁短轴[PSAX]的单搏或多搏缩放3D图像、PSAX的多搏实时3D图像以及胸骨旁长轴的单搏或多搏全容积3D图像）可从胸骨旁窗口获得二尖瓣叶的完整评分，而在心房颤动患者中，通过1种方案（PSAX的单搏缩放3D图像）可获得完整评分。所有3D模式下，所有患者的腱索评分均不完整。

结论

所提出的3D经胸超声心动图方案适用于所有患者，无论其回声窗口和心律如何，均可实现二尖瓣的完整评分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/92f4d3328ab4/JCE-29-7-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/1ee6ef9e01b3/JCE-29-7-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/895b0482797c/JCE-29-7-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/b8065d69d59a/JCE-29-7-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/fc2b937f744d/JCE-29-7-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/92f4d3328ab4/JCE-29-7-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/1ee6ef9e01b3/JCE-29-7-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/895b0482797c/JCE-29-7-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/b8065d69d59a/JCE-29-7-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/fc2b937f744d/JCE-29-7-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc1/6450232/92f4d3328ab4/JCE-29-7-g005.jpg

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本文引用的文献

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Current Clinical Applications of Three-Dimensional Echocardiography: When the Technique Makes the Difference.三维超声心动图的当前临床应用：当技术产生差异时。
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