三维超声用于功能性二尖瓣反流修复手术评估的临床应用研究  

Clinical application of 3D-TEE in the evaluation of mitral valve repair due to functional mitral regurgitation

作　　者：左明良 尹立雪 李春梅 邓燕 罗玲 向毅[2] 向波 于涛 Zuo Mingliang;Yin Lixue;Li Chunmei;Deng Yan;Luo Ling;Xiang Yi;Xiang Bo;Yu Tao(Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital;1 Department of Thoracic Surgery, The Fourth People＇s Hospital of Sichuan Province;Department of Cardiac Surgery,Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital)

机构地区：[1]四川省医学科学院.四川省人民医院心血管超声及心功能科,成都610071 [2]四川省第四人民医院胸外科,成都610071 [3]四川省医学科学院.四川省人民医院心脏外科,成都610071

出　　处：《重庆医科大学学报》2018年第8期1061-1066,共6页Journal of Chongqing Medical University

基　　金：四川省科技厅资助项目(编号:2016TD0017;2017TD0015)

摘　　要：目的:探讨三维超声诊断功能性二尖瓣反流(functional mitral regurgitation,FMR)的价值,并探索二尖瓣修复的安全性及有效性。方法:50例因主动脉瓣狭窄(aortic stenosis,AS)或关闭不全(aortic regurgitation,AR)行主动脉瓣置换,伴或不伴功能性二尖瓣反流患者,对所有患者均行二维超声及三维经食管超声心动图(three-dimensional transesophageal echocardiography,3D-TEE)检查,比较外科直视测量二尖瓣对合缘高度值与3D-TEE测值的差异。对于中度以上FMR患者主动脉瓣置换基础上行二尖瓣修复,对比未修复患者心脏超声、围手术期死亡、主动脉阻断时间、重症加强护理病房(intensive care unit,ICU)停留天数,以及术后反流纠正效果。结果:二尖瓣修复24例,未修复者26例,2组间基线数据比较差异无统计学意义;2组间比较二维经胸超声及3D-TEE参数,修复组较未修复组反流程度重,瓣环面积扩大(P=0.009),对合缘高度减少(P=0.008),差异具有统计学意义。所有患者外科直视测量与三维超声心动图测量二尖瓣对合缘高度的方法具有较好的一致性。术中主动脉阻断时间及术后ICU停留天数差异无统计学意义(P=0.381,P=0.175)。二尖瓣修复组围手术期死亡1例,未修复组死亡1例,2组间差异无统计学意义(P=0.891)。术后半年二尖瓣修复组2例二尖瓣轻度反流,无一例二尖瓣狭窄及反流加重发生;二尖瓣未修复组出现1例二尖瓣反流加重,1例轻度反流。此外,二尖瓣修复患者中,AS所致FMR二尖瓣环面积小于AR患者(P=0.028),瓣缘对合高度大于AR(P=0.017)。结论:主动脉瓣置换术同期行二尖瓣修复安全可行。3D-TEE评估FMR反流机制具有重要价值,FMR往往伴随瓣环扩张,二尖瓣闭合障碍。AS及AR并发FMR的发生机制可能不同,建议AS并发FMR修复时以瓣环扩大及瓣缘对合高度为标准。Objective：To investigate the value of three-dimensional transesophageal echocardiography（3D-TEE）in the diagnosis of functional mitral regurgitation（FMR）,and to explore the clinical safety and efficacy of mitral valve repair. Methods：Fifty cases of aortic stenosis（AS）or aortic regurgitation（AR）underwent aortic valve replacement（AVR）,with or without FMR. All patients were treated with two-dimensional echocardiography and three-dimensional transesophageal echocardiography（3D-TEE）. For patients with moderate to severe FMR,mitral valve repair was performed on the basis of aortic valve replacement. Echocardiographic parameters,perioperative death,aortic clamping time,intensive care unit（ICU）stay,and postoperative regurgitation correction were compared. Results：There were 24 cases of mitral valve repair and 26 cases without repair. There was no significant difference in base-line data between the 2 groups. The more serious MR,the larger mitral annular area（P =0.009）,the smaller coaptation height（P=0.008）were found in MV repair group than in non repair group. There was a good consistency of mitral valve coaptation height between direct surgery and 3D-TEE measurement. There was no significant difference in aortic clamping time and postoperative ICU stay days（P=0.381,P=0.175）. In mitral valve repair group,1 cases died during perioperative period,and 1 cases died in the non repair group. There was no significant difference between the 2 groups（P=0.891）. Half a year follow-up of regurgitation corrective effect,there were 2 cases of mild mitral regurgitation,no case of mitral stenosis and regurgitaion aggravated in mitral valve repair group.There were 1 case of deteriorational mitral regurgitation and 1 case of mild mitral regurgitation in non-MV repair group. In addition,in mitral valve repair patients,the area of FMR mitral annulus caused by AS was smaller than that of AR patients（P=0.028）,and the coaptation height of mitral valve was higher than that of AR（P=0.017）.

关 键 词：主动脉瓣置换 功能性二尖瓣反流 二尖瓣成形 三维经食管超声心动图 

分 类 号：R654.2[医药卫生—外科学]