摘要
目的探讨实时三维经食管超声心动图(RT3D-TEE)对二尖瓣成形术(PBMV)患者二尖瓣立体结构的定量评价作用。方法25例行PBMV的二尖瓣脱垂患者,均进行术前及术后RT3D-TEE检查。术前对二尖瓣进行三维重建,定位脱垂的小叶区域与外科术中所见对照,测量术前及术后二尖瓣环及瓣叶的各个参数。分析RT3D-TEE对二尖瓣脱垂的诊断结果;对比患者手术前后二尖瓣定量参数[瓣环的最小三维面积(A3Dmin)、三维周长(C3D)、瓣叶的暴露面积(A3DE)、高度(H)、瓣环高度与前外侧至后内侧直径的比率(H/DALPm)、前后直径(DAP)、瓣环前外侧至后内侧直径(DALPm)、对合面积(CoapA)、对合指数(CPI)、瓣环收缩功能指数];分析术后复查结果。结果25例患者的二尖瓣小叶数量为150个,RT3D-TEE显示7例患者是多个小叶脱垂(A2+A3区1例、P1+P2区2例、P2+P3区1例、A2+P2+P3区2例、A2+A3+P1区1例)。将手术结果作为诊断金标准,RT3D-TEE诊断中仅有1例A2+A3区患者被误诊为仅A2区脱垂,RT3D-TEE的诊断灵敏度为97.22%(35/36),特异度为100.00%(114/114),阳性预测值为100.00%(35/35),阴性预测值为99.13%(114/115)。术后,25例患者A3Dmin、C3D、A3DE、H、H/DALPm、DAP、DALPm均低于术前,CoapA、CPI、E2D、瓣环收缩功能指数均高于术前,差异具有统计学意义(P<0.05)。20例患者完成了术后3个月复查,二尖瓣反流均为轻微或轻度反流,较术中RT3DTEE显示的情况基本无改变。10例患者进行了1年后复查,其中1例患者出现重度反流,1例出现中度反流。结论RT3D-TEE能对二尖瓣的三维形态进行直观呈现,预测术后远期效果,因此,RT3D-TEE对二尖瓣立体结构进行定量评估在PBMV中具有重要意义。
Objective To explore the quantitative evaluation of mitral valve structure in patients with percutaneous balloon mitral valvuloplasty(PBMV)by real-time three-dimensional transesophagea echocardiography(RT3D-TEE).Methods 25 patients with mitral valve prolapsis who underwent PBMV were selected,and all underwent preoperative and postoperative RT3D-TEE examinations.Preoperative threedimensional reconstruction of the mitral valve was performed,and the area of the prolapsed leaflet was located and compared with the surgical findings.Various parameters of the mitral valve annulus and leaflets were measured before and after surgery.Analysis of the diagnostic results of RT3D-TEE for mitral valve prolapse;comparison of the quantitative parameters of the mitral valve minimum area of the three-dimensional view of the annulus(A3Dmin),three dimensional circumference(C3D),three-dimensional exposed area of the leaflet(A3DE),height(H),ratio of annulus height to anterolated-to-posteromedial diameter(H/DALPm),anterior-to-posteior diameter(DAP),anterolateal-to-posteromedial diameter(DALPm),coaptation area(CoapA),coaptation index(CPI),and annulus contraction function index before and after surgery;analysis of the results of postoperative review.Results Among 25 patients,a total of 150 mitral valve leaflets were observed.RT3D-TEE revealed that 7 patients had multi-segment prolapse,specifically:1 case in the A2+A3 segments,2 cases in the P1+P2 segments,1 case in the P2+P3 segments,2 cases in the A2+P2+P3 segments,1 case in A2+A3+P1 segments.Taking the surgical outcome as the gold standard for diagnosis,in the RT3D-TEE diagnosis,only 1 patient in the A2+A3 segments was misdiagnosed as having prolapse only in the A2 segment;the diagnostic sensitivity of RT3D-TEE was 97.22%(35/36),the specificity was 100.00%(114/114),the positive predictive value was 100.00%(35/35),and the negative predictive value was 99.13%(114/115).After surgery,the levels of A3Dmin,C3D,A3DE,H,H/DALPm,DAP and DALPm in 25 patients were all lower than those before surgery,while CoapA,CPI,E2D and annulus contractile function index were all higher than those before surgery,and the differences were statistically significant(P<0.05).20 patients completed a 3-month postoperative review,and mitral regurgitation was mild or slight regurgitation,which was essentially unchanged from that shown by intraoperative RT3D-TEE.10 patients underwent a 1-year postoperative review,in which 1 patient showed severe regurgitation and one showed moderate regurgitation.Conclusion RT3D-TEE can clearly display the three-dimensional morphology of mitral valve,and predict long term postoperative results.Therefore,the quantitative evaluation of the three-dimensional structure of the mitral valve by RT3D-TEE is of great significance in PBMV.
作者
钟晓娇
周翠翠
胡碧娟
黄智华
黄志平
ZHONG Xiao-jiao;ZHOU Cui-cui;HU Bi-juan(Ultrasound Department,Ganzhou People's Hospital,Ganzhou 341000,China)
出处
《中国现代药物应用》
2025年第15期1-5,共5页
Chinese Journal of Modern Drug Application
基金
赣州市指导性科技计划项目(项目编号:GZ2020ZSF147)。
关键词
实时三维经食管超声心动图
二尖瓣成形术
二尖瓣立体结构
Real-time three-dimensional transesophagea echocardiography
Percutaneous balloon mitral valvuloplasty
Mitral valve structure
