Limbu Y R, Shen X, Pan C, Shi Y, Chen H
Shanghai Institute of Cardiovascular Diseases, Shanghai Medical University, P.R. China.
Clin Cardiol. 1998 Jun;21(6):415-8. doi: 10.1002/clc.4960210609.
Thickening of mitral leaflets in rheumatic mitral valve stenosis is well described in necropsy studies; however, volume computation of the thickening mitral leaflets has not been attempted. 4trial fibrillation is one of the complications of rheumatic mitral stenosis. Quantitative assessment of thickened mitral valve and its relation to clinical complications is clinically desirable.
The study was undertaken to compare measurement of mitral valve volume in normal subjects and in patients with rheumatic mitral valve stenosis.
An HP Sonos 2500 echocardiographic system with 5 MHz multiplane transesophageal transducer was used for data acquisition, and TomTec Echoscan computer setup was used to off-line volume computation. Study subjects included 10 normal subjects (mean age 44.8 years) and 36 patients with rheumatic mitral valve stenosis (22 female, 14 male) with an age range of 25 to 69 years (mean age 47 +/- 9.6 years). Mitral valve volumes were compared between the normal subjects and patients with mitral valve stenosis, and further comparison was made between the sinus rhythm (SR) and atrial fibrillation (AF) groups in patients with mitral valve stenosis. In all study subjects, the mitral valve area (MVA) was determined by two-dimensional echocardiography.
Quantitative three-dimensional (3-D) echocardiography showed that mitral valve volume was significantly larger in patients with mitral valve stenosis than in normal subjects (9.0 +/- 2.2 and 4.5 +/- 0.7 ml, respectively, p < 0.001). When patients with mitral valve stenosis were divided into the SR and AF groups, mitral valve volume was found to be significantly larger in the AF group than in the SR group (9.76 +/- 2.2 ml. and 7.72 +/- 1.5 ml, respectively, p < 0.01) and patients in the AF group tended to be older (p < 0.05) with larger left atrial diameter (LAD) (p < 0.01). However, MVA between the two groups showed no statistical significance (1.1 +/- 0.43 and 1.0 +/- 0.34 cm2, respectively, p > 0.2). When the study subjects were divided into two groups (< 50 and > or = 50 years) according to age, the comparison of mitral valve volume between these two groups (9.37 +/- 2.18 and 8.56 +/- 2.14 ml, p > 0.2) showed no statistical significance.
Quantitative 3-D echocardiography can be applied for the measurement of mitral valve volume in vivo. Patients with rheumatic mitral valve stenosis with atrial fibrillation have a propensity to have a larger mitral valve volume and are older than the patients with sinus rhythm; however, the age per se does not seem to be a cause for larger mitral valve volume.
风湿性二尖瓣狭窄时二尖瓣叶增厚在尸检研究中已有充分描述；然而，尚未尝试对增厚的二尖瓣叶进行体积计算。房颤是风湿性二尖瓣狭窄的并发症之一。临床上需要对增厚的二尖瓣及其与临床并发症的关系进行定量评估。
本研究旨在比较正常受试者与风湿性二尖瓣狭窄患者的二尖瓣体积测量值。
使用配备5MHz多平面经食管探头的惠普Sonos 2500超声心动图系统进行数据采集，并使用TomTec Echoscan计算机设置进行离线体积计算。研究对象包括10名正常受试者（平均年龄44.8岁）和36例风湿性二尖瓣狭窄患者（22例女性，14例男性），年龄范围为25至69岁（平均年龄47±9.6岁）。比较正常受试者与二尖瓣狭窄患者的二尖瓣体积，并对二尖瓣狭窄患者的窦性心律（SR）组和房颤（AF）组进行进一步比较。在所有研究对象中，通过二维超声心动图确定二尖瓣面积（MVA）。
定量三维（3-D）超声心动图显示，二尖瓣狭窄患者的二尖瓣体积明显大于正常受试者（分别为9.0±2.2和4.5±0.7ml，p<0.001）。当将二尖瓣狭窄患者分为SR组和AF组时，发现AF组的二尖瓣体积明显大于SR组（分别为9.76±2.2ml和7.72±1.5ml，p<0.01），且AF组患者年龄偏大（p<0.05），左心房直径（LAD）更大（p<0.01）。然而，两组之间的MVA无统计学意义（分别为1.1±0.43和1.0±0.34cm²，p>0.2）。当根据年龄将研究对象分为两组（<50岁和≥50岁）时，两组之间二尖瓣体积的比较（9.37±2.18和8.56±2.14ml，p>0.2）无统计学意义。
定量三维超声心动图可用于体内二尖瓣体积的测量。合并房颤的风湿性二尖瓣狭窄患者的二尖瓣体积往往更大，且年龄比窦性心律患者大；然而，年龄本身似乎并不是二尖瓣体积增大的原因。
