多平面经食管三维超声心动图对二尖瓣狭窄的诊断价值

采用多平面经食管三维超声心动图（３Ｄ－Ｅｃｈｏ）对１５例二尖瓣狭窄（ＭＳ）患者的二尖瓣口面积（ＭＶＡ）进行了定量研究。通过心脏三维重建仪平行切割二尖瓣结构衍生出８个从二尖瓣环至瓣尖的等距离短轴平面，能够发现并测量代表最小ＭＶＡ的平面。结果显示３Ｄ－Ｅｃｈｏ测量的ＭＶＡ与多普勒压力半降时间（ＰＨＴ）导出的ＭＶＡ高度相关（ｒ＝０．９８，Ｐ值＜０．００１），经胸两维超声心动图（２Ｄ－Ｅｃｈｏ）的测量的ＭＶＡ与３Ｄ－Ｅｃｈｏ测量的ＭＶＡ仅中度相关（ｒ＝０．８１Ｐ值＜０．０１），２Ｄ－Ｅｃｈｏ测量的ＭＶＡ平均大于３Ｄ－Ｅｃｈｏ测量的ＭＶＡ０．４５ｃｍ２，这可能与从胸骨旁短轴切面上难以切扫到最小的瓣口平面有关。本研究表明３Ｄ－Ｅｃｈｏ为定量评价ＭＳ患者的ＭＶＡ提供一种新的检查方法。     

尿毒症心脏病变的超声心动图及多普勒研究

目的：探讨超声心动图及多普勒在尿毒症患者所致心脏病变的诊断中的应用价值。方法：本文选用３０例超声心动图及多普勒资料完整的病例作为病例组并随机抽取正常人３０例作为对照组。结果：尿毒症组与对照组各测值统计学处理，差异显著。左室腔明显扩大，左室心肌重量和左空心肌重量指数明显增加（Ｐ＜０．０１），左室收缩功能ＥＦ与ＦＳ无差异（Ｐ＞０．０５），反映泵血功能的ＳＶ、ＥＳＶ、ＥＤＶ和ＣＯ增高（Ｐ＜０．０５－Ｐ＜０．０１）；反映左室舒张功能的二尖瓣血流频谱Ａ峰、ＡＩ、Ｅ／Ａ和 ＩＶＲＴ均有增大（ Ｐ＜ ０．０５－ Ｐ＜ ０．０１），肺静脉血流频谱 Ｄ波、ＤＩ和 ＲＦＩ明显减少， Ｓ／Ｄ ＡＲ和 ＡＲＤ均有明显增加（Ｐ＜０．０１），左室舒张功能下降明显。结论：超声心动图与多普勒在尿毒症患者心脏病变的检查诊断中有极高的应用价值。     

冠状动脉病变支数对二维和三维超声心动图左室功能测量准确性的影响

为了探讨冠状动脉病变支数对二维（２ＤＥ）和三维超声心动图（３ＤＥ）左室功能测量结果的影响，应用多平面经食管３ＤＥ技术测量了９例冠状动脉单支血管病变患者（Ａ组）及１１例多支血管病变患者（Ｂ组）的左室舒张末期容量（ＥＤＶ）、收缩末期容量（ＥＳＶ）、心搏量（ＳＶ）及射血分数（ＥＦ），并与２ＤＥ及左室造影（ＬＶＡ）的测值进行了对比，结果显示：①在Ａ、Ｂ两组患者中２ＤＥ测量的ＥＤＶ、ＥＳＶ、ＳＶ及ＥＦ与ＬＶＡ相应测值仅呈中度相关，３ＤＥ则均呈高度相关，且３ＤＥ所测ＥＤＶ、ＥＳＶ对左室造影结果的低估程度仅为２ＤＥ方法的一半；②在Ａ、Ｂ两组患者中，２ＤＥ所测ＥＦ均高于左室造影结果（Ｐ＜０．０１），３ＤＥ所测ＥＦ则与左室造影测值无显著性差异（Ｐ＞０．０５）。③Ｂ组患者的ＥＦ用２ＤＥ、３ＤＥ及ＬＶＡ三种方法测量均较Ａ组患者明显降低（Ｐ＜０．０５），而ＥＤＶ则显著增加（Ｐ＜０．０５）。     

经胸动态三维超声心动图对二尖瓣狭窄患者瓣口面积的评价

采用经胸动态三维超声心动图（３Ｄ－Ｅｃｈｏ）对１５例二尖瓣狭窄（ＭＳ）患者的二尖瓣口面积（ＭＶＡ）进行了定量研究。通过心脏三维重建仪平行切割二尖瓣结构衍生出８个从二尖瓣环至瓣尖的等距离短轴平面，从中能够确定并测量代表最小ＭＶＡ的平面。结果显示３Ｄ－Ｅｃｈｏ测量的ＭＶＡ与多普勒压力半降时间（ＰＨＴ）导出的ＭＶＡ高度相关（ｒ＝０．９７，Ｐ＜０．００１），经胸二维超声心动图（２Ｄ－Ｅｃｈｏ）测量的ＭＶＡ与３Ｄ－Ｅｃｈｏ测量的ＭＶＡ仅中度关连（ｒ＝０．８３，Ｐ＜０．０１），２Ｄ－Ｅｃｈｏ测量的ＭＶＡ平均大于３Ｄ－Ｅｃｈｏ测量的ＭＶＡ为０．３８ｃｍ２，这可能与从胸骨旁短轴切面上难以切扫到最小的瓣口平面有关。本研究表明３Ｄ－Ｅｃｈｏ为定量评价ＭＳ患者的ＭＶＡ提供了一种更准确的全新影像技术。     

三维超声心动图对冠心病患者左心功能的研究并与核素心血池造影、二维及M型超声相对照

本文应用三维超声心动图（３ＤＥ）图像再建技术对２０例冠心病患者与年龄、性别相配对的１５例正常人进行了左心功能研究，并与二维（２ＤＥ）、Ｍ型超声心动图（ＭＭＥ）及核素心血池造影（ＲＮＡ）进行对照。结果发现：①３ＤＥ对其中１２例冠心病患者所测左室射血分数（ＥＦ）与ＲＮＡ的相关系数（ｒ＝０．９４）明显高于２ＤＥ（ｒ＝０．７１）（Ｐ＜０．０１）；②３ＤＥ、２ＤＥ、ＭＭＥ三种超声方法所测左室容量（ＬＶＶ）与ＥＦ，在正常组三者差别无显著性（Ｐ＞０．０５），在冠心病组三者均有差别（Ｐ＜０．０１）；③ＭＭＥ对正常组与冠心病组的ＬＶＶ测值与ＥＦ，两组差别无显著性（Ｐ＞０．０５），而３ＤＥ、２ＤＥ对正常组与冠心病组的ＬＶＶ测值与ＥＦ，两组差别有显著意义（Ｐ＜０．０１），３ＤＥ所测得差别大于２ＤＥ；④正常组低心肌节段收缩率（＜１０％）占总面积的７．８７％，而冠心病组占２４．４５％（Ｐ＜０．０１）。作者认为，在左室形状有变化的病理心脏，３ＤＥ对ＬＶＶ及ＥＦ等心功能参数的测定具有相当好的准确性，明显优于２ＤＥ及ＭＭＥ。     

超声心动图评价房间隔缺损患者左心室收缩功能

用超声心动图检测２８例继发孔型房间隔缺损（ＡＳＤ）患者及４０例正常人左心室收缩功能（ＬＶＳＦ）。结果表明：ＡＳＤ患者左室射血分值（ＬＶＥＦ）、短轴缩短分数（ＬＶＦＳ）、每搏量（ＳＶ）、心输出量（ＣＯ）、主动脉瓣口血流速度（ＡＶ）、速度时间积分（ＡＶＩ）均较正常人明显降低（Ｐ＜０．００１～０．０５），左室射血前期（ＬＰＥＰ）延长（Ｐ＜０．０１）、射血时间（ＬＶＥＴ）缩短（Ｐ＜０．０５）、ＬＰＥＰ／ＬＶＥＴ增大（Ｐ＜０．０１），且ＬＶＥＦ、ＬＶＦＳ、ＳＶ、ＣＯ、ＡＶ、ＡＶＩ与肺／体循环量比值（Ｑｐ／Ｑｓ）呈中度负相关（ｒ＝－０．３９～－０．７８，Ｐ＜０．０５）。结论认为：ＡＳＤ患者ＬＶＳＦ存在一定程度的减退，并推测其机理可能与ＡＳＤ患者因右室容量超荷所致的左室扩张性降低、舒张末容积减小、室间隔运动异常及左室几何形态改变等有关     

经胸二维和多平面经食管三维超声心动图测量慢性肺心病右室收缩功能的对比研究

目的探讨慢性肺心病右室收缩功能的测量新方法。方法对３２例慢性肺心病患者进行经胸二维和多平面经食管超声心动图检查,分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超声心动图软件系统测量右室射血分数（ＲＶＥＦ）,并与放射性核素心室造影测量的ＲＶＥＦ对比。结果经胸二维超声心动图与放射性核素心室造影的ＲＶＥＦ呈中度相关（ｒ＝０．０８,Ｐ＜０．０１,ＳＥＥ＝０．０７）,但前者显著高估了后者的测值（Ｐ＜０．０５）。而多平面经食管三维超声心动图与放射性核素心室造影的测值高度相关（ｒ＝０．９１,Ｐ＜０．００１,ＳＥＥ＝０．０５）,且组间均数无显著性差异（Ｐ＞０．０５）。结论多平面经食管三维超声心动图为定量评价右室收缩功能提供了相对无创和相当可靠的新途径。     

多普勒超声心动图评价二尖瓣位人工生物瓣血流动力学性能

应用多普勒超声心动图技术对５５例置换于二尖瓣位的三种不同生物瓣的血流动力学指标进行了观察。结果表明，置换于二尖瓣位三种生物瓣的有效瓣口面积（ＥＯＡ）分别为：ＢＮ型２．６±０．４ｃｍ２，Ｐｅｒｆｅｃｔ型为２．３±０．２ｃｍ２，Ｃａｒｐｅｎｔｉｅｒ－Ｅｄｗａｒｄｓ瓣为２．３±０．６２ｃｍ，其中ＢＮ瓣的ＥＯＡ最大（Ｐ值＜０．０５），后两种瓣间的ＥＯＡ无显著差别（Ｐ值＞０．０５），三种生物瓣的峰值流速（Ｖｍａｘ）、峰值压差（ＰＧ）、及平均压差（ＭＧ）无显著差别（Ｐ值均＞０．０５）。     

多普勒超声心动图对急性心肌梗塞患者溶栓治疗的评价

目的：探讨多普勒超声心动图对不同梗塞部位急性心肌梗塞（ＡＭＩ）溶栓治疗再通评价的意义。方法：对１６０例首次ＡＭＩ患者随机分成尿激酶溶栓治疗再通组和常规治疗对照组，采用彩色多普勒超声心动图测定左房内径（ＬＡＤ）、室间隔和左室后壁运动最小幅度（ＩＶＳＡ和ＬＶＰＷＡ）、左室射血分数（ＥＦ）、二尖瓣Ｅ点至室间隔距离（ＥＰＳＳ）和二尖瓣血流频谱Ａ峰最大速度与Ｅ峰最大速度比（Ａ／Ｅ）。结果：①溶栓治疗者再通率为５８．８２％（７０／１１９）。②急性前壁心肌梗塞（ＡＡＭＩ）患者的ＬＡＤ、ＥＰＳＳ和Ａ／Ｅ在溶栓组明显低于对照组（Ｐ＜０．０１，Ｐ＜０．０１，Ｐ＜０．０１）；溶栓再通组ＥＦ明显高于对照组（Ｐ＜０．０１）。③急性下壁心肌梗塞（ＡＩＭＩ）患者ＬＶＰＷＡ溶栓再通组高于对照组（Ｐ＜０．０５）；溶栓再通组Ａ／Ｅ明显低于对照组（Ｐ＜０．０１）。④ＡＡＭＩ＋ＡＩＭＩ患者ＥＦ在溶栓再通组明显高于对照组（Ｐ＜０．０１）；ＥＰＳＳ低于对照组（Ｐ＜０．０５）。结论：溶栓治疗可限制梗塞面积，挽救濒死心肌，改善左室功能。在梗塞部位上，前壁优于下壁，ＡＡＭＩ＋ＡＩＭＩ介于两者之间。     

多平面经食管三维超声心动图定量评价冠心病患者左室收缩功能

应用多平面经食管三维超声心动图技术（３ＤＥ）对３０例冠心病患者的左室容量、射血分数等心功能指标进行了分析，并与两维超声心动图（２ＤＥ）及心血管左室造影（ＬＶＡ）所测值进行了对比，结果显示：２ＤＥ所测左室舒张末期容量、收缩末期容量、心搏量及射血分数与左室造影相应指标呈中度相关，而３ＤＥ则与左室造影相应测值呈高度相关（Ｐ值＜０．０１）；２ＤＥ所测左室射血分数（ＥＦ）高于左室造影结果（Ｐ值＜０．０５），３ＤＥ所测ＥＦ与左室造影结果无显著差异（Ｐ值＞０．０５）。表明在冠心病患者中，经食管３ＤＥ仍可较准确地定量评价左室功能，其准确性优于２ＤＥ方法，为左室收缩功能的定量评价提供了简便可行的新途径     

Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling

Comprehensive visual and quantitative analysis of in vivo human mitral valve morphology is central to the diagnosis and surgical treatment of mitral valve disease. Real-time 3D transesophageal echocardiography (3D TEE) is a practical, highly informative imaging modality for examining the mitral valve in a clinical setting. To facilitate visual and quantitative 3D TEE image analysis, we describe a fully automated method for segmenting the mitral leaflets in 3D TEE image data. The algorithm integrates complementary probabilistic segmentation and shape modeling techniques (multi-atlas joint label fusion and deformable modeling with continuous medial representation) to automatically generate 3D geometric models of the mitral leaflets from 3D TEE image data. These models are unique in that they establish a shape-based coordinate system on the valves of different subjects and represent the leaflets volumetrically, as structures with locally varying thickness. In this work, expert image analysis is the gold standard for evaluating automatic segmentation. Without any user interaction, we demonstrate that the automatic segmentation method accurately captures patient-specific leaflet geometry at both systole and diastole in 3D TEE data acquired from a mixed population of subjects with normal valve morphology and mitral valve disease.     

Patient-Specific Mitral Valve Closure Prediction Using 3D Echocardiography

This article presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (TEE). Our approach uses physics-based modeling to solve for the stationary configuration of the closed valve structure from the patient-specific open valve structure, which is recovered using a user-in-the-loop, thin-tissue detector segmentation. The method uses a tensile shape-finding approach based on energy minimization. This method is employed to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using 10 intraoperative 3D TEE sequences by comparing the closed valve configuration predicted from the segmented open valve with the segmented closed valve, taken as ground truth. Experiments show promising results, with prediction errors on par with 3D TEE resolution and with good potential for applications in pre-operative planning.     

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85‐year‐old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D‐TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D‐TEE were compatible with those measured by fluoroscopy. Moreover, RT3D‐TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D‐TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :64–67, 2015     

New quantitative three-dimensional echocardiographic indices of mitral valve stenosis

Background We studied the value of quantitative three-dimensional echocardiography (3DE) in the evaluation of mitral valve stenosis using the measurement of the mitral valve area (MVA) with two new indices: the doming volume and mitral valve volume. Methods and results A total of 45 consecutive patients with mitral valve stenosis were studied. MVA was measured using Doppler with the pressure half-time (PHT) method. Following a diagnostic multiplane transesophageal (TEE) examination, data for 3DE were acquired with a rotational mode of acquisition. MVA was assessed by anyplane echocardiography (APE) and from surface rendered images. Moreover, the doming volume, i.e., the volume subtended by the anterior and posterior mitral valve and annular cut plane was measured by APE. Comparing PHT-derived with 3DE-derived MVA’s, using both APE and surface rendered images, only moderate correlations were observed: PHT-derived MVA versus APE-derived MVA: r = 0.74, P < 0.0001; PHT-derived area versus 3DE-surface rendered MVA: r = 0.70, P < 0.0001. Multiple linear regression analysis showed a relation of atrial fibrillation to the doming volume (P = 0.04), but not to PHT-derived MVA (P = 0.28), APE-derived area (P = 0.33) and mitral valve volume (P = 0.08). Comparison of patients with MVA < 1 cm² and MVA > 1 cm² revealed significant difference in mitral valve volume: mean mitral valve volume in critical stenosis was 3.7 ml versus 1.4 ml in non-critical stenosis (P = 0.04). Conclusions Only moderate correlations between 3DE and Doppler-derived MVA’s were observed. Measurement of the doming volume allows quantification of the 3DE geometry of the mitral apparatus. Patients with conical or funnel-like geometry are more likely to have sinus rhythm, whereas, patients with flat geometry are likely to have atrial fibrillation. Mitral valve volume can be used for the evaluation of mitral stenosis severity. These new 3DE indices might be used for selection of patients for balloon valvuloplasty.     

Current management of mitral valve prolapse

Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.     

New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Nonsurgical management of patients with symptomatic mitral valve stenosis has been established as the therapeutic modality of choice for two decades. Catheter-based balloon dilation of the stenotic valvular area has been shown, at least, as effective as surgical interventions. Unfavorable results of catheter-based interventions are largely due to unfavorable morphology of the valve apparatus, particularly leaflets calcification and subvalvular apparatus involvement. A mitral valve score has been proposed in Boston, MA, about two decades ago, based on morphologic assessment of mitral valve apparatus by two-dimensional (2D) echocardiography to predict successful balloon dilation of the mitral valve. Several other scores have been developed in the following years in order to more successfully predict balloon dilatation outcome. However, all those scores were based on 2D echocardiography, which is limited by ability to distinguish calcification and subvalvular involvement. The introduction of new matrix-based ultrasound probe has allowed 3D echocardiography (3DE) to provide more detailed morphologic analysis of mitral valve apparatus including calcification and subvalvular involvement. Recently, a new 3DE scoring system has been proposed by our group, which represents an important leap into refinement of the use of echocardiography guiding mitral valve interventions.     

实时三维经食管超声心动图在二尖瓣成形术中的应用研究

目的 探讨术中实时三维经食管超声心动图(RT-3D TEE)判断二尖瓣病变区域的准确性,以及评价二尖瓣成形术效果的价值.方法 19例因二尖瓣反流(MR)拟接受二尖瓣成形术患者,采集术前、术后RT-3D TEE图像,将术前所见与术中发现进行比较,并在术后即刻评价手术疗效.结果 RT-3DTEE诊断二尖瓣叶病变与术中发现完全相符16例,3例不符合,其中1例术前诊断前叶中间段、后叶中间段脱垂,术中仅发现瓣环扩大,瓣膜黏液退行性变;1例术前诊断后叶后内段脱垂,术中发现后叶中间段及后内段腱索断裂;1例术前提示瓣环扩大,术中发现后叶中间段脱垂.2D TEE诊断二尖瓣病变与术中发现完全相符仅10例,且对二尖瓣脱垂患者难以明确脱垂的确切瓣区和范围.术后即刻观察成形术效果,其中18例RT-3DTEE显示微量至少量二尖瓣反流,1例术后仍为中重度反流,改行二尖瓣置换术,二尖瓣成形术的成功率为94.7%.结论 RT-3D TEE明显提高了二尖瓣反流病因及病变部位定位的诊断准确性,在二尖瓣成形术手术方案制定及疗效的即刻评估方面发挥了非常重要的作用.     

Transesophageal echocardiographic recognition of infiltrative cardiac sarcoma mimicking mitral stenosis

Primary cardiac sarcomas are very rare. Infiltrative cardiac tumors may be difficult to diagnose by transthoracic echocardiography (TTE) only. Herein, we report a case of primary unclassified cardiac sarcoma with clinical and echocardiographic manifestations of mitral stenosis (MS). The tumor was not identified by TTE preoperatively because of its diffuse infiltration of the left atrial wall and both mitral leaflets without protruding mass, and was only discovered by intraoperative transesophageal echocardiography (TEE). This report alerts clinicians that TEE is a necessary adjunctive tool to facilitate the correct diagnosis in patients with obscure etiologies of mitral valve diseases especially when they will receive surgical intervention.     

动态三维超声心动图评价二尖瓣关闭不全

本文采取经胸壁及经食道旋转扫描方法获取二维数据，利用总体重建法（ＶｏｌｕｍｉｃＲｅｎｄｅｒｉｎｇＤｉｓｐｌａｙ）对１２例正常人二尖瓣，１４例风心病二尖瓣关闭不全，２０例二尖瓣脱垂患者的二尖瓣解剖结构及二尖瓣返流束进行了动态三维超声心动图重建。重建图像能从左室或左房侧显示二尖瓣装置的整体三维空间结构及动态变化。正常二尖瓣叶光滑平软，舒张期瓣口充分开放，收缩期前后叶对合良好。风心病二尖瓣关闭不全患者瓣叶增厚，收缩期前后叶之间出现裂缝。二尖瓣脱垂时瓣叶某一部分呈“瓢匙”样向左房侧脱出。动态三维超声心动图还能显示二尖瓣关闭不全血液返流束的立体形态及在左房内的空间走向。初步经验表明动态三维超声心动图对二尖瓣关闭不全的诊断有重要临床价值