经食管实时三维超声定量评价二尖瓣反流二尖瓣瓣叶及瓣环几何形态

发布时间：2018-04-26 02:17

本文选题：经食道超声心动图 + 缺血性二尖瓣反流　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的使用经食道实时三维超声心动图（RT-3D-TEE）对缺血性二尖瓣反流(ischemic mitral regurgitation, IMR)和非缺血性二尖瓣反流(mitral regurgitation，MR)患者二尖瓣瓣叶及瓣环三维几何构型进行对比研究，探讨不同病因致二尖瓣反流时瓣叶及瓣环形态变化规律，为心脏外科手术治疗提供依据。方法选取98例行RT-3D-TEE检查的患者入选本研究。患者分3组:缺血性二尖瓣反流（IMR）组43例、非缺血性二尖瓣反流组33例,无二尖瓣反流组（正常对照组）22例。所有患者均在局部麻醉下行经食管实时三维超声心动图(PhilipsIE33彩色多普勒超声诊断仪，经食道三维超声探头X7-2t)检查。分别采集二尖瓣瓣环与瓣叶结构的全容积三维动态超声图像，运用Qlab7.0MVQ软件对图像进行脱机分析，，获得三维小叶面积（A3DE）、前小叶面积（A3DE Ant）、后小叶面积（A3DE Post）、二尖瓣瓣环周长（C3D）、瓣环的前外侧至后内侧直径（DAlPm）、瓣环的前后直径（DAP）、二尖瓣瓣环高度（H）、最大脱垂高度（HProl）、最大遮盖高度（HTent）、小叶脱垂体积（Vprol）、小叶遮盖体积（Vtent）、主动脉口二尖瓣环平面夹角（θ）、前小叶角度（θAnt）、非平面小叶角度（θNPA）、后小叶角度（θPost）等二尖瓣瓣环及瓣叶的各项形态学参数测值，并进行统计分析。结果与对照组相比，IMR}D在A3DE、A3DE Ant、DAP以及θNPA均显著增大，θ和θPost减小，差异具有统计学意义(P＜0．05)；与对照组相比，非缺血性MR组在A3DE、A3DE Ant、DAP、HProl、Vprol以及θNPA均显著增大，θ、θAnt以及θPost减小，差异具有统计学意义(P＜0．05)；与非缺血性MR组相比，IMR组在A3DE、A3DE Ant、DAP、Hprol以及θNPA均较小，在θAnt以及θPost均较大，差异具有统计学意义(P＜0．05)。结论两组二尖瓣反流组均可导致二尖瓣瓣环扩张、瓣叶面积增大，以及二尖瓣瓣环几何构型发生改变，整个瓣环倾向于扁平化，以上改变在非缺血性MR组比IMR组更为明显，且非缺血性MR组出现脱垂比IMR组更为常见。因此，IMR患者与非缺血性MR患者二尖瓣瓣叶及瓣环几何构型改变有明显不同，提示非缺血性MR组瓣叶及瓣环的损害可能更为严重。
[Abstract]:Objective to compare the three-dimensional geometry of mitral lobe and annulus in patients with ischemic mitral regurgitation mitral regurgitation, IMR) and non-ischemic mitral regurgitation using RT-3D-TEE transesophageal real-time echocardiography. To investigate the morphological changes of valve lobe and annulus in mitral regurgitation caused by different etiology, and to provide basis for cardiac surgery. Methods 98 patients with RT-3D-TEE were included in this study. The patients were divided into 3 groups: ischemic mitral regurgitation (IMR) group (n = 43), non-ischemic mitral regurgitation group (n = 33) and no mitral regurgitation group (n = 22). All patients underwent transesophageal real-time three-dimensional echocardiography with Philips IE33 color Doppler echocardiography and transesophageal three-dimensional ultrasound probe X7-2t under local anesthesia. The full-volume three-dimensional dynamic ultrasound images of mitral annulus and lobes were collected, and the images were analyzed offline by Qlab7.0MVQ software. Three-dimensional lobular area (A3DEA), anterior lobular area (A3DE Antler), posterior lobular area (A3DE Postanus), circumference of mitral annulus (C3DU), anterolateral to medial annular diameter (DAlPmN), anteroposterior diameter of annulus (DAPP), mitral annulus height, maximum proll height (HProlA), maximum masking of mitral annulus were obtained. The morphological parameters of mitral annulus and lobes, such as the height of the lid, the proll volume of lobules, the covering volume of the lobules, the planar angle of the aortic orifice mitral annulus (胃), the angle of the anterior lobules (胃 -Antl), the angle of the non-planar lobules (胃 NPAA), the angle of the posterior lobules (胃 Postl), and so on, were measured. Statistical analysis was carried out. Results compared with the control group, IMR} D in A3DEA3DE NPA and 胃 NPA increased significantly, 胃 and 胃 Post decreased, the difference was statistically significant (P < 0.05), compared with the control group, the non-ischemic Mr group in A3DEA3DEA3DE DAPHProl and 胃 NPA increased significantly, 胃 Ant and 胃 Post decreased. The difference was statistically significant (P < 0.05), and the difference was statistically significant in A3DEA3DE DAPHprol and 胃 NPA, and in 胃 Ant and 胃 Post (P < 0.05). Conclusion both mitral regurgitation groups can result in mitral annulus dilatation, mitral lobe area enlargement, and mitral annular geometry changes. The whole annulus tends to flatten. These changes are more obvious in non-ischemic Mr group than in IMR group. Prolapse was more common in non-ischemic Mr group than in IMR group. Therefore, the geometric changes of mitral valve lobe and annulus in IMR patients were significantly different from those in non-ischemic Mr patients, suggesting that the damage of mitral lobe and annulus might be more serious in non-ischemic Mr patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R542.5

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