Applebaum R M, Kasliwal R R, Kanojia A, Seth A, Bhandari S, Trehan N, Winer H E, Tunick P A, Kronzon I
Department of Medicine, New York University School of Medicine, New York, USA.
J Am Coll Cardiol. 1998 Nov;32(5):1405-9. doi: 10.1016/s0735-1097(98)00386-6.
We investigated the role of three-dimensional echocardiography in assessing mitral valve anatomy in greater detail in patients immediately before and after balloon mitral valvuloplasty (BMV).
Three-dimensional echocardiography is a recently developed, evolving imaging technique that allows visualization of intracardiac structures from any perspective.
We studied 19 patients undergoing BMV using transesophageal echocardiography (TEE) (Chicago, Illinois) to image the mitral valve. The TEE was interfaced to a TomTec three-dimensional workstation that allows electrocardiographic and respiratory cycle gated image acquisition. The acquired images are digitized, and after postprocessing a three-dimensional image is reconstructed. The mitral valve was viewed "en-face" as if looking up from the left ventricle.
The mean mitral valve area (by pressure half-time from the Doppler of the two-dimensional echocardiogram) increased after BMV from 0.86+/-0.06 cm2 to 2.07+/-0.10 cm2, p < 0.0001. This was similar to the mitral valve areas obtained by planimetry from the three-dimensional images. The three-dimensional reconstructions showed a complete commissural split in 10 patients and partial splitting in 9 patients. In three of the eight patients who had an increase in the amount of mitral regurgitation secondary to BMV, the three-dimensional reconstructions were able to detect tears within the valve leaflet. One leaflet tear actually extended up to the mitral valve annulus and was associated with the only case of severe mitral regurgitation.
The three-dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and leaflet tears not seen on the two-dimensional echocardiogram became visible.
我们研究了三维超声心动图在球囊二尖瓣成形术（BMV）前后即刻更详细评估二尖瓣解剖结构中的作用。
三维超声心动图是一种最近开发且不断发展的成像技术，可从任何角度可视化心内结构。
我们使用经食管超声心动图（TEE）（伊利诺伊州芝加哥）对19例接受BMV的患者进行研究，以成像二尖瓣。TEE与TomTec三维工作站相连，该工作站允许进行心电图和呼吸周期门控图像采集。采集的图像被数字化，经过后处理重建三维图像。二尖瓣从左心室向上看时以“正面”视角观察。
BMV后二尖瓣平均面积（通过二维超声心动图多普勒压力减半时间测量）从0.86±0.06 cm²增加到2.07±0.10 cm²，p<0.0001。这与通过三维图像面积测量法获得的二尖瓣面积相似。三维重建显示10例患者出现完全的瓣叶联合分离，9例患者出现部分分离。在8例因BMV导致二尖瓣反流增加的患者中，三维重建在3例中检测到瓣叶撕裂。其中1例瓣叶撕裂实际上延伸至二尖瓣环，并与唯一1例严重二尖瓣反流病例相关。
三维超声心动图重建能够可视化二尖瓣，使二维超声心动图上未见的瓣叶联合分离和瓣叶撕裂变得可见。
