Breburda C S, Griffin B P, Pu M, Rodriguez L, Cosgrove D M, Thomas J D
Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
J Am Coll Cardiol. 1998 Aug;32(2):432-7. doi: 10.1016/s0735-1097(98)00239-3.
We sought to validate direct planimetry of mitral regurgitant orifice area from three-dimensional echocardiographic reconstructions.
Regurgitant orifice area (ROA) is an important measure of the severity of mitral regurgitation (MR) that up to now has been calculated from hemodynamic data rather than measured directly. We hypothesized that improved spatial resolution of the mitral valve (MV) with three-dimensional (3D) echo might allow accurate planimetry of ROA.
We reconstructed the MV using 3D echo with 3 degrees rotational acquisitions (TomTec) using a transesophageal (TEE) multiplane probe in 15 patients undergoing MV repair (age 59 +/- 11 years). One observer reconstructed the prolapsing mitral leaflet in a left atrial plane parallel to the ROA and planimetered the two-dimensional (2D) projection of the maximal ROA. A second observer, blinded to the results of the first, calculated maximal ROA using the proximal convergence method defined as maximal flow rate (2pi(r2)va, where r is the radius of a color alias contour with velocity va) divided by regurgitant peak velocity (obtained by continuous wave [CW] Doppler) and corrected as necessary for proximal flow constraint.
Maximal ROA was 0.79 +/- 0.39 (mean +/- SD) cm2 by 3D and 0.86 +/- 0.42 cm2 by proximal convergence (p = NS). Maximal ROA by 3D echo (y) was highly correlated with the corresponding flow measurement (x) (y = 0.87x + 0.03, r = 0.95, p < 0.001) with close agreement seen (AROA (y - x) = 0.07 +/- 0.12 cm2).
3D echo imaging of the MV allows direct visualization and planimetry of the ROA in patients with severe MR with good agreement to flow-based proximal convergence measurements.
我们试图验证从三维超声心动图重建中对二尖瓣反流口面积进行直接面积测量法的准确性。
反流口面积（ROA）是二尖瓣反流（MR）严重程度的一项重要指标，迄今为止一直是根据血流动力学数据计算得出，而非直接测量。我们推测，三维（3D）超声心动图提高的二尖瓣（MV）空间分辨率可能使ROA的面积测量法更为准确。
我们使用经食管（TEE）多平面探头，通过3D超声心动图的3度旋转采集（TomTec）对15例接受MV修复的患者（年龄59±11岁）的MV进行重建。一名观察者在与ROA平行的左心房平面中重建脱垂的二尖瓣叶，并对最大ROA的二维（2D）投影进行面积测量。第二名观察者对第一名观察者的结果不知情，使用近端会聚法计算最大ROA，近端会聚法定义为最大流速（2π(r2)va，其中r是具有速度va的彩色混淆轮廓的半径）除以反流峰值速度（通过连续波[CW]多普勒获得），并根据需要对近端血流限制进行校正。
3D测量的最大ROA为0.79±0.39（均值±标准差）cm2，近端会聚法测量的最大ROA为0.86±0.42 cm2（p=无显著性差异）。3D超声心动图测量的最大ROA（y）与相应的流量测量值（x）高度相关（y = 0.87x + 0.03，r = 0.95，p < 0.001），两者吻合度良好（面积测量法计算的ROA差值（y - x）= 0.07±0.12 cm2）。
MV的3D超声心动图成像可直接显示重度MR患者的ROA并进行面积测量，与基于流量的近端会聚测量结果吻合度良好。
