超声心动图综合评估继发性三尖瓣反流  

The Insight into Secondary Tricuspid Regurgitation by Two and Three-dimensional Echocardiography

作　　者：孟红[1] 王浩[1] 潘世伟[2] 逄坤静[1] 李建蓉[1] 王燕[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院超声科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心外科,北京市100037

出　　处：《中国超声医学杂志》2015年第4期326-328,共3页Chinese Journal of Ultrasound in Medicine

基　　金：中央级公益性科研院所基金(No.2010-F12)

摘　　要：目的合并左心瓣膜疾病的继发性三尖瓣反流(TR)日益成为诊治焦点。本研究意在规范测量三尖瓣瓣环和瓣叶闭合高度,明确正常参考值,探寻影响TR的多重因素。方法对51例正常人及170例左心瓣膜疾病的患者进行二维、三维超声心动图检查。对比不同超声切面下的瓣径和闭合高度测值;术前三维超声观察瓣叶。145例患者接受了左心瓣膜置换或成形手术。结果心房横径比值为1.35,可以帮助选择超声切面测量。瓣环直径指数≥21mm/m2,闭合高度>4.11mm(前隔交界)是正常临界值。回归分析显示瓣径和闭合高度是影响TR的主要独立危险因素。术前三维超声发现瓣叶风湿受累的有38例。结论结合心房横径比值可以准确测量瓣环直径和瓣叶闭合高度。与单纯观察反流程度相比,瓣环直径指数、瓣叶闭合高度可以作为瓣膜存在功能改变的更可信指标。三维超声可以直观地观察瓣叶结构。Objective The determinants of secondary tricuspid regurgitation （TR） have not been established clearly.The goal of this study is to explore the determinants and to establish the normal values.Methods 51 normal subjects and 170 patients with left-sided valvular diseases underwent echo examinations.In the multiple echo views,tricuspid annulus diameters （TAD） and leaflet tethering distances were measured.Results Our study showed that the LA / RA equal to 1.35 could identify the best echo views to evaluate TAD.TAD adjusted by body surface area （BSA-TAD） and leaflet tethering distances were emerged as independent predictors of TR.38 patients were found rheumatic involvements of tricuspid leaflets by 3D echo.Conclusions Ratio of bi-atrial width （1.35） could help to select optimal echo views to measure TAD and tethering distance.TAD and tethering distance could provide compact evidences of the valvular pathologies.Furthermore,3D echocardiography could give us more detail information of the valves.

关 键 词：三尖瓣反流 瓣环直径 体表面积 瓣叶闭合高度 

分 类 号：R445.1[医药卫生—影像医学与核医学]