经食管动态三维重建超声显像在二尖瓣脱垂治疗中的应用  

Application of transesophageal dynamic three-dimensional echocardiography in surgical treatment of mitral valve prolapse

作　　者：林贻梅[1] 沈学东[1] 林佑善[1] 潘翠珍[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《中华超声影像学杂志》2004年第1期23-25,共3页Chinese Journal of Ultrasonography

摘　　要：目的　探讨经食管动态三维重建超声的二尖瓣装置声像图特征及其在术中评估二尖瓣修复术后即时疗效的价值。方法　 3 3例行二尖瓣手术的患者 (16例瓣膜重建术患者和 17例瓣膜置换术患者 )于术前或术中予以三维超声重建 ,观察两组瓣膜脱垂的部位、范围 ,对瓣膜重建术患者行即时疗效评估 ,并明确残余反流机制。结果　瓣膜重建组 16例患者均为后叶脱垂 ,脱垂累及 2个段者 4例 ,脱垂平均面积(0 .80± 1.5 9)cm2 。换瓣组 17例患者中 ,单纯后叶脱垂 3例 ,脱垂累及 2个段者 13例 ,脱垂平均面积 (1.3 9± 0 .91)cm2 (P <0 .0 5 )。与二维超声显像比较 ,三维超声新发现腱索冗长 2例 ,二尖瓣前叶脱垂 4例。瓣膜修复术后即刻经食管彩色多普勒血流显像示 :无或轻微二尖瓣反流 10例 ,轻度反流 5例 ,轻中度反流 1例。 5例轻度二尖瓣反流的患者再次三维重建发现 3例瓣膜对合欠佳 ,2例存在后叶轻度残余脱垂而二维超声未能发现。结论　三维超声显像能很好地显示二尖瓣装置 ,尤其在精确定位二尖瓣脱垂的部位和测量其大小、范围上占有优势。Objective To study transesophageal three dimensional echocardiography in the postoperative effect evaluation of the mitral valve apparatus.Methods Thirty three patients with mitral valve prolapse were examined by three dimensional echocardiography preoperatively or intraoperatively.Among them 16 patients underwent mitral vavle reconstruction and 17 patients underwent mitral vavle replacement,the location and size of mitral valve prolapse(MVP) were observed in two groups.Postoperative three dimensional echocardiography was performed to show the mechanism of residual mitral regurgitation(MR).Results In the group of mitral valve reconstruction,three dimensional echocardiography showed that all of the patients had posterior mitral leaflet prolapse,the lesion involved two segments in 4 cases,the average area of mitral leaflet prolapse was ( 0.80 ± 1.59 ) cm 2.While in the group of mitral valve replacement,only 3 patients with isolated posterior mitral leaflet prolapse,the lesion involved two segments in 13 cases, the average area of mitral leaflet prolapse was ( 1.39 ± 0.91 ) cm 2 (P< 0.05 ).Additional information can be provided by three dimensional echocardiography compared with transesophageal echocardiography(TEE),including 2 cases with chordae elongation,4 cases with anterior mitral leaflet prolapse.Postpump intraoperative TEE revealed that 10 cases with no or slight MR,1 case with mild to moderate MR whose mitral valve replacement was given immediately.Mild MR occurred in 5 patients because residual mild prolapse still existed in 2 cases and mitral malcoaptation existed in 3 cases observed by three dimensional echocardiography.Conclusions Transesophageal three dimensional echocardiography facilitates imaging of some features of mitral valve apparatus and provides additional information for comprehensive assessment of mitral valve abnormalities.

关 键 词：经食管动态三维重建 超声显像 二尖瓣脱垂 治疗 声像图特征 二尖瓣修复术 

分 类 号：R542.51[医药卫生—心血管疾病]