动态三维超声心动图对正常和病变二尖瓣器的临床研究

目的探讨动态三维超声心动图对二尖瓣器评分的价值。方法通过多平面经食管三维超声心动图容积提取显示法（３ＤＶ）对２０例正常二尖瓣、８例二尖瓣狭窄、１２例二尖瓣关闭不全和１０例二尖瓣位人工机械瓣患者的二尖瓣器进行了评分，并与取自三维数据集的任意切面超声心动图（ＡＰＥ）和多平面经食管二维超声心动图（ＴＥＥ）对照。结果３ＤＶ对正常和病变二尖瓣的活动度、连合部、瓣口面积和与毗邻结构的空间关系的评分显著高于ＴＥＥ和ＡＰＥ（Ｐ＜０．０１和Ｐ＜０．０５）。３ＤＶ对病变二尖瓣的诊断价值更优于正常二尖瓣。它对瓣叶厚度、瓣环和瓣下结构的评分低于ＴＥＥ和ＡＰＥ（Ｐ＜０．０１）。三种检查方法对二尖瓣位人工机械瓣的评分无显著性差异（Ｐ＞０．０５）。结论３ＤＶ对评价正常和病变二尖瓣器提供了一种有特殊价值的新方法。

Clinical study of dynamic three-dimensional echocardiography of normal and pathologic mitral valve apparatus

Objective To score the mitral valve apparatus by dynamic threedimensional echocardiography. Methods 20 patients with normal mitral valve and 30 patients with variety of mitral valve pathology (stenosis 8, insufficiency 12 and prosthesis 10) were studied. From the threedimensional data sets, cut planes were selected and presented in twodimensional format(anyplane echocardiography, APE) and volume rendered dynamic display (3DV) for comparison with the twodimensional multiplane transesophageal echocardiography (TEE). Results Different features of both normal and pathologic mitral valve were defined and subjectively scored for clarity of visualization and confidence of interpretation. 3DV was superior to APE and TEE for the evaluation of relationship with other structures, leaflets mobility, commissures and orifice( P <0.01 and P <0.05). In particular, the assessment of the mitral valve apparatus with 3DV was superior in pathologic than in normal valves. In contrast, leaflets thickness, subvalvular apparaus and annulus were scored lower using 3DV ( P <0.01). Prosthesis were equally evaluated by the three methods ( P >0.05). Conclusions Dynamic threedimensional echocardiography would offer the unique advantage to directly evaluate the normal and pathologic mitral valve.