纤维弹性组织缺陷性二尖瓣关闭不全与马方综合征患者三尖瓣装置的几何学：实时三维经食管超声心动图研究。
Geometry of Tricuspid Valve Apparatus in Patients with Mitral Regurgitation due to Fibroelastic Deficiency versus Barlow Disease: A Real-Time Three-dimensional Transesophageal Echocardiography Study.
机构信息
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
出版信息
J Am Soc Echocardiogr. 2020 Sep;33(9):1095-1105. doi: 10.1016/j.echo.2020.04.019. Epub 2020 Jun 16.
BACKGROUND
Tricuspid valve (TV) geometry gained attention when the prognostic significance of tricuspid regurgitation (TR) was determined. However, the TV geometric characteristics in Barlow disease (BD) have not been elucidated. This study aimed to clarify the difference in TV morphology between BD and fibroelastic deficiency (FED) and the effect of its geometry on residual TR after tricuspid annuloplasty (TAP) using three-dimensional (3D) transesophageal echocardiography.
METHODS
Based on the mitral valve (MV) morphology defined by 3D transesophageal echocardiography, 106 patients with degenerative MV disease were classified into BD (n = 42) and FED (n = 64). Three-dimensional images of the TV were analyzed using a quantification software to compare the geometrical parameters. Among them, 35 patients (17 with BD and 18 with FED) underwent concomitant TAP during MV surgery, and the residual TR after TAP was evaluated within 1 month.
RESULTS
TV annulus area, billowing height, and billowing volume were greater in BD than in FED (10.8 ± 2.9 vs 9.2 ± 2.4 cm, 4.6 ± 1.6 vs 2.3 ± 1.1 mm, and 1.3 ± 0.8 vs 0.3 ± 0.3 mL; all P < .01). In contrast, TV tenting height and tenting volume were smaller in BD than in FED (2.6 ± 1.5 vs 4.4 ± 2.4 mm and 0.3 ± 0.4 vs 0.9 ± 1.0 mL; both P < .01). These morphologic differences in TV were similar to those in MV. There was a strong correlation between MV billowing volume and TV billowing volumes (R = 0.83, P < .01). The prevalence of significant residual TR after TAP was greater in BD than in FED (35% vs 0%, P < .01). Moderate correlations between TV billowing height and volume and residual TR after TAP were observed (R = 0.47 and 0.49, respectively, both P < .01).
CONCLUSIONS
Patients with BD exhibited larger TV annulus area and billowing than FED patients. These results suggest that degenerative changes in the TV apparatus in BD patients are similar to that seen in the MV apparatus. These findings should be taken into consideration when a TV surgery is required.
背景
当确定三尖瓣反流（TR）的预后意义时，三尖瓣（TV）几何形状引起了关注。然而，巴洛病（BD）的 TV 几何特征尚未阐明。本研究旨在使用三维（3D）经食管超声心动图阐明 BD 与弹性纤维缺失（FED）之间 TV 形态的差异，以及 TV 几何形状对三尖瓣环成形术（TAP）后残余 TR 的影响。
方法
根据 3D 经食管超声心动图定义的二尖瓣（MV）形态，将 106 例退行性 MV 疾病患者分为 BD（n=42）和 FED（n=64）。使用定量软件分析 TV 的三维图像，比较几何参数。其中，35 例患者（17 例 BD，18 例 FED）在 MV 手术期间同时进行 TAP，术后 1 个月内评估 TAP 后的残余 TR。
结果
BD 的 TV 瓣环面积、膨出高度和膨出体积大于 FED（10.8±2.9 与 9.2±2.4cm，4.6±1.6 与 2.3±1.1mm，1.3±0.8 与 0.3±0.3mL；均 P<0.01）。相反，BD 的 TV 瓣叶抬高高度和瓣叶抬高体积小于 FED（2.6±1.5 与 4.4±2.4mm 和 0.3±0.4 与 0.9±1.0mL；均 P<0.01）。TV 的这些形态差异与 MV 的相似。MV 膨出体积与 TV 膨出体积之间存在很强的相关性（R=0.83，P<0.01）。TAP 后残余 TR 的发生率在 BD 中高于 FED（35%与 0%，P<0.01）。TV 膨出高度和体积与 TAP 后残余 TR 之间存在中度相关性（R=0.47 和 0.49，均 P<0.01）。
结论
BD 患者的 TV 瓣环面积和膨出大于 FED 患者。这些结果表明，BD 患者的 TV 装置退行性变化与 MV 装置相似。在需要进行 TV 手术时，应考虑这些发现。
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