Castini D, Gentile F, Mangiarotti E, Donzelli W, Ornaghi M, Leali F, Triulzi M O, Maggi G C
Divisione di Cardiologia, Utic Marco O. Triulzi, Ospedale Bassini, Milano.
G Ital Cardiol. 1993 Jul;23(7):689-98.
The present study was designed in order to evaluate the prevalence of mitral regurgitation in patients with the "incomplete mitral leaflet closure" echocardiographic pattern, to verify whether the amount of "incomplete mitral leaflet closure" is related to the severity of mitral regurgitation and, last, to verify the relation between the "incomplete mitral leaflet closure" and left ventricular morphology and function.
We studied 80 patients (14 patients with dilatative cardiomyopathy, 26 patients with coronary artery disease, and 40 patients with hypertensive heart disease or aortic valve disease) showing the "incomplete mitral leaflet closure" pattern, retrospectively selected from a population composed of 1700 consecutive patients routinely examined in our echocardiographic laboratory. In all patients we evaluated the presence and the severity of mitral regurgitation, the morphological and functional parameters of the left ventricle, the systolic diameter of the mitral annulus, the distance between the point of mitral leaflet coaptation and the annular plane, and the incomplete mitral closure area, assuming the last two parameters as indexes of the severity of incomplete closure of the mitral valve.
We observed the presence of mitral regurgitation in 51 out of 80 patients (64%). The valvular insufficiency was considered mild in 78% of the patients. We observed no significant difference between patients with mitral regurgitation and without, as regards the diameter of the mitral annulus, the distance between the point of mitral leaflet coaptation and the annular plane, and the incomplete mitral closure area in different types of heart diseases. The incomplete mitral closure area and the diameter of the mitral annulus showed a significant, although not elevated, correlation with the severity of the mitral regurgitation (r = 0.36 and r = 0.32, respectively). The severity of mitral regurgitation showed significant correlations with all of the left ventricular morphological and functional parameters evaluated. Finally, we observed significant correlations between the incomplete mitral closure area and all of the morphological and functional parameters of the left ventricle.
On the basis of the results obtained we can conclude that: 1) the "incomplete mitral leaflet closure" pattern does not appear to be a highly specific marker of mitral regurgitation, 2) this pattern appears to be related to the morphology and function of the left ventricle, and 3) the severity of the incomplete mitral valve closure is more easily evaluated by a parameter that takes into account the numerous factors acting on the mitral apparatus, that is the incomplete mitral closure area.
本研究旨在评估具有“二尖瓣叶不完全闭合”超声心动图表现的患者中二尖瓣反流的患病率，验证“二尖瓣叶不完全闭合”的程度是否与二尖瓣反流的严重程度相关，最后验证“二尖瓣叶不完全闭合”与左心室形态和功能之间的关系。
我们研究了80例表现出“二尖瓣叶不完全闭合”模式的患者（14例扩张型心肌病患者、26例冠状动脉疾病患者以及40例高血压性心脏病或主动脉瓣疾病患者），这些患者是从我们超声心动图实验室常规检查的1700例连续患者中回顾性选取的。在所有患者中，我们评估了二尖瓣反流的存在及严重程度、左心室的形态和功能参数、二尖瓣环的收缩期直径、二尖瓣叶对合点与瓣环平面之间的距离以及二尖瓣不完全闭合面积，将后两个参数作为二尖瓣不完全闭合严重程度的指标。
我们在80例患者中的51例（64%）中观察到二尖瓣反流。78%的患者瓣膜关闭不全被认为是轻度的。在不同类型心脏病中，有二尖瓣反流和无二尖瓣反流的患者在二尖瓣环直径、二尖瓣叶对合点与瓣环平面之间的距离以及二尖瓣不完全闭合面积方面，我们未观察到显著差异。二尖瓣不完全闭合面积和二尖瓣环直径与二尖瓣反流的严重程度显示出显著相关性，尽管相关性不高（分别为r = 0.36和r = 0.32）。二尖瓣反流的严重程度与所评估的所有左心室形态和功能参数均显示出显著相关性。最后，我们观察到二尖瓣不完全闭合面积与左心室的所有形态和功能参数之间存在显著相关性。
基于所获得的结果，我们可以得出以下结论：1）“二尖瓣叶不完全闭合”模式似乎不是二尖瓣反流的高度特异性标志物；2）这种模式似乎与左心室的形态和功能相关；3）通过一个考虑到作用于二尖瓣装置的众多因素的参数，即二尖瓣不完全闭合面积，更容易评估二尖瓣不完全闭合的严重程度。
