二尖瓣反流的二尖瓣环三维构型改变分析

发布时间：2018-11-02 19:11

【摘要】：目的二尖瓣环扩张和变形是产生二尖瓣反流(MR)的重要机制之一，本研究通过实时三维超声心动图（RT-3DE）对二尖瓣及瓣环构型在心动周期中的动态变化进行定量分析，探讨二尖瓣环结构异常与MR反流程度的关系。方法运用飞利浦IE33彩超仪采集41例MR患者的实时三维超声心动图二尖瓣环图像，根据二尖瓣反流程度分为轻度反流组（18例）与重度反流组（23例）两组；选取21例二尖瓣无反流的正常人作为对照组。用德国TomTec公司4D图像工作站重建二尖瓣环三维动态图像，测量二尖瓣环三维前后径(AP)、三维交界径(CC)、三维前外后内径(ALPM)、前瓣环长度(AAL)、后瓣环长度(PAL)、三维瓣环周长(AC)、瓣环球形指数(SI)、非平面角度(NPA)、瓣环面积(MAA)等各参数。并且在近二尖瓣水平，对左心室心肌进行斑点追踪分析，计算应变（S）与位移（D）。结果正常对照组21例的二尖瓣环三维构型均呈马鞍形态，并在整个心动周期中始终保持此形态。轻度反流组的二尖瓣环三维构型也呈马鞍形态，且在整个心动周期中保持马鞍形。重度反流组的二尖瓣环虽呈马鞍形态，但在整个心动周期中，，呈扁平圆形。轻度反流组AP、CC、ALPM、NPA、PAL、AC、MAA均较对照组增大，差异具有统计学上的显著性意义（P＜0.05)。重度反流组不仅AP、CC、ALPM、NPA、MAA、 PAL、AC、较正常组增大，同时AAL也较正常组增大，并且AP、ALPM较轻度反流组进一步增大（P0.05）,差异具有统计学上的显著性差异（P＜0.05)。结论本文采用RT-3DE方法探讨了病理性MR患者二尖瓣环三维结构与MR产生机制的关系，提示病理性MR除了二尖瓣叶病变以外，二尖瓣环的三维立体形态可能导致不同程度的MR，具有马鞍形态特征的三维二尖瓣环仅产生轻度反流；偏扁平圆形马鞍形态三维二尖瓣环立体构型易导致重度反流。轻度MR多见二尖瓣环后瓣环长度（PAL）增加，重度MR不仅出现PAL增加，而且AAL也增加。
[Abstract]:Objective mitral annulus dilatation and deformity are one of the important mechanisms of mitral regurgitation (MR). In this study, the dynamic changes of mitral valve and annular configuration during cardiac cycle were quantitatively analyzed by real-time three-dimensional echocardiography (RT-3DE). To investigate the relationship between mitral annular anomalies and MR reflux. Methods Real-time three-dimensional echocardiographic mitral annulus images of 41 patients with MR were collected by Philips IE33 color Doppler echocardiography. According to the degree of mitral regurgitation, they were divided into two groups: mild regurgitation group (18 cases) and severe regurgitation group (23 cases). 21 normal persons without mitral regurgitation were selected as control group. Three-dimensional dynamic images of mitral annulus were reconstructed by 4D imaging workstation of TomTec Company in Germany. The length of (ALPM), anterior and posterior annulus (AAL),) was measured by measuring the three-dimensional anteroposterior diameter of mitral annulus (AP),) and the three-dimensional junction diameter (CC),). Length of posterior annulus (PAL), circumference of three dimensional annulus (AC), valve universal index (SI), non-planar angle (NPA), annulus area (MAA) and so on. The strain (S) and displacement (D). Were calculated by dot-tracing analysis of left ventricular myocardium at near mitral valve level. Results the three dimensional configuration of mitral annulus in 21 cases of normal control group showed saddle shape and remained in this shape throughout the cardiac cycle. The three dimensional configuration of mitral annulus in mild regurgitation group was also a saddle shape and remained saddle shape during the whole cardiac cycle. The mitral annulus in severe regurgitation group was in the shape of saddle, but in the whole cardiac cycle, it was flat and round. AP,CC,ALPM,NPA,PAL,AC,MAA in mild reflux group was significantly higher than that in control group (P < 0. 05). The AP,CC,ALPM,NPA,MAA, PAL,AC, of severe reflux group was not only higher than that of normal group, but also the AAL of severe reflux group was larger than that of normal group, and AP,ALPM was further increased compared with mild reflux group (P0.05). The difference was statistically significant (P < 0.05). Conclusion the relationship between the three dimensional structure of mitral annulus and the mechanism of MR production in patients with pathological MR was studied by using RT-3DE method. It is suggested that the three-dimensional morphology of the mitral annulus in pathological MR may lead to different degrees of MR, in addition to the mitral lobe lesion. The three dimensional mitral annulus with saddle shape produced only mild regurgitation. The three-dimensional mitral annulus with a flat circular saddle is prone to severe regurgitation. In mild MR, the length of posterior mitral annulus (PAL) was increased, and severe MR not only increased in PAL, but also increased in AAL.
【学位授予单位】：内蒙古医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R541.1;R363

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