实时三维超声定量评估功能性二尖瓣反流二尖瓣装置形态学及动力学的临床研究  

Clinical study on morphology and dynamics of mitral valve device in patients with different types of functional mitral regurgitation by real-time three-dimensional echocardiography

作　　者：王柳青 宋宏宁[1] 曹省[1] 胡波[1] 谭团团[1] 周青[1] 陈金玲[1] Wang Liuqing;Song Hongning;Cao Sheng;Hu Bo;Tan Tuantuan;Zhou Qing;Chen Jinling(Department of Ultrasound,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉430060

出　　处：《中华超声影像学杂志》2023年第8期656-663,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82102046)。

摘　　要：目的应用实时三维超声定量评估心房功能性二尖瓣反流(AFMR)与心室功能性二尖瓣反流(VFMR)患者二尖瓣装置形态及动力学并进行比较, 拟为此两类患者的诊断及临床治疗提供理论依据。方法回顾性纳入2022年5-11月于武汉大学人民医院行经食管超声心动图检查的AFMR患者20例(AFMR组)和VFMR患者20例(VFMR组), 另选取同期因卵圆孔未闭或者非心脏手术术中监测等行经食管超声心动图检查患者20例作为对照组。所有研究对象均在等容舒张期、舒张早期、舒张中期、舒张晚期、等容收缩期、收缩早期、收缩中期及收缩晚期定量测量二尖瓣环前后径(AP径)、前外后内径(ALPM径)、前后径/前外后内径(AP/ALPM)、连和径(CW)、瓣环面积(AA)、瓣环周长(AC)、瓣环高度(AH)、对合深度(CD)、帐篷容积(TV)、空间角(NPA)、后叶角等, 并计算以上参数的总变化率及收缩期变化率。比较三组间二尖瓣装置静态结构和动态变化差异, 分析二尖瓣环各参数变化率与左心室长轴应变(GLS)的相关性。结果①三组GLS表现为对照组>AFMR组>VFMR组, 且各组间差异有统计学意义(均P<0.05)。②静态结构:AFMR组与VFMR组瓣环AP径、ALPM径、CW、AA、AC、二尖瓣前后瓣叶面积及其总面积(TLA)明显大于对照组(均P<0.05), 但AFMR组与VFMR组之间差异无统计学意义(均P>0.05)。与其他两组相比, VFMR组TV、CD、后叶角显著增大, 表现出瓣叶栓系(均P<0.05)。三组中对照组AH/CW最大, 鞍形最深;AFMR组TLA/AA最小, 瓣叶重塑最少;三组接合面积差异无统计学意义(均P>0.05)。③动态变化:在整个心动周期中对照组AP径、ALPM径、AA和AC呈规律性变化, 从等容舒张期至舒张晚期逐渐减小, 从等容收缩期开始至收缩晚期又逐渐增大;而AFMR组及VFMR组上述参数变化显得更加紊乱和无序, 此外与对照组相比, AFMR组AP径总变化率及收缩期变化率显著减小, 但ALPM径总变化Objective To quantitatively evaluate and compare the morphology and dynamics parameters of mitral valve devices in patients with atrial functional mitral regurgitation(AFMR)and ventricular functional mitral regurgitation(VFMR)by real-time three-dimensional ultrasound,in order to provide theoretical basis for diagnosis and clinical treatments of the two types of regurgitation patients.Methods A retrospective study was conducted on 20 AFMR patients(AFMR group)and 20 VFMR patients(VFMR group)who underwent transesophageal echocardiography at Wuhan University People′s Hospital from May to November 2022.Additionally,20 patients who underwent transesophageal echocardiography at our hospital during the same period due to patent foramen ovale or non cardiac surgery monitoring were selected as the control group.All subjects were measured mitral annulus anteroposterior diameter(AP diameter),anterolateral posteromedial diameter(ALPM diameter),anteroposterior diameter/anterolateral posteromedial diameter(AP/ALPM),commissural width(CW),annular area(AA),annular circumference(AC),annular height(AH),coaptation depth(CD),tenting volume(TV),non-planar angle(NPA)and posterior leaflet angle at isovolumic relaxation time,early diastole,mid diastole,late diastole,isovolumic contraction time,early systole,mid systole,and late systole.The total change rate and systolic change rate of the above parameters were calculated,the differences in structure and dynamic changes of the mitral valve device among three groups were compared,and the correlations between the change rate of mitral annular parameters and left ventricular long axis strain(GLS)were analyzed.Results①The GLS of three groups were as follows:control group>AFMR group>VFMR group,and the differences between the groups were statistically significant(all P<0.05).②Static structure:The AP diameter,ALPM diameter,AA,AC,and total leaflet area(TLA)of the AFMR group and VFMR group were significantly larger than those of the control group(all P<0.05),but there was no statistically sig

关 键 词：超声心动描记术 实时三维 功能性二尖瓣反流 二尖瓣功能 二尖瓣形态 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]