Cheng T O, Xie M X, Wang X F, Li Z A, Hu G
George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Am Heart J. 1997 Jan;133(1):120-9. doi: 10.1016/s0002-8703(97)70257-6.
To observe the stereoscopic structure and the motion of the prolapsing mitral valve and its regurgitant jet in comparison with the normal mitral valve, four-dimensional (or dynamic three-dimensional) echocardiography of mitral valve apparatus was obtained in 20 patients with mitral valve prolapse and 10 unaffected subjects by use of transthoracic and transesophageal methods. The normal mitral valve apparatus has a consistent saddle-shaped configuration, with its anterior and posterior high points located near the aortic root and posterior left ventricular wall, respectively, and its low points located medially and laterally. In mitral valve prolapse, the spatial relation of mitral leaflets and anulus can be observed in four dimensions either from the left ventricle toward the left atrium or from the left atrium toward the left ventricle; the position, size, shape, motion, and extent of functional abnormality of the prolapsing mitral valve were clearly displayed. On the long-axis view of the left ventricle and the apical four-chamber view of four-dimensional echocardiography, the part of prolapsing mitral valve that protruded into the left atrium appeared as a spoon-like depression. We also obtained four-dimensional images of regurgitant blood flow to observe the stereoscopic view of blood flow column and its cross-sectional area, spatial position, and dynamic changes. This technique is of great value in evaluating patients with mitral valve prolapse, increasing the diagnostic sensitivity and specificity, and giving assistance to the surgeons in making preoperative therapeutic decisions and assessing the intraoperative and postoperative results.
为观察二尖瓣脱垂时二尖瓣及其反流束的立体结构和运动，并与正常二尖瓣进行比较，采用经胸和经食管方法，对20例二尖瓣脱垂患者和10例未受影响的受试者进行了二尖瓣装置的四维（或动态三维）超声心动图检查。正常二尖瓣装置呈一致的鞍形结构，其前后高点分别位于主动脉根部和左心室后壁附近，低点位于内侧和外侧。在二尖瓣脱垂时，可从左心室向左心房或从左心房向左心室四个维度观察二尖瓣叶与瓣环的空间关系；脱垂二尖瓣功能异常的位置、大小、形状、运动及程度均清晰显示。在左心室长轴视图和四维超声心动图的心尖四腔视图上，突入左心房的脱垂二尖瓣部分呈勺状凹陷。我们还获取了反流血流的四维图像，以观察血流柱的立体视图及其横截面积、空间位置和动态变化。该技术在评估二尖瓣脱垂患者、提高诊断敏感性和特异性以及协助外科医生做出术前治疗决策和评估术中及术后结果方面具有重要价值。
