Four-tiered echocardiographic analysis approach for congenital mitral valve malformations: Four years of experience
Four-tiered echocardiographic analysis approach for congenital mitral valve malformations: Four years of experience
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DOI：
10.1016/j.ijcard.2016.10.090
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发表时间：
2017-01-15
影响因子：
3.5
通讯作者：
Li, Dongyu
中科院分区：
文献类型：
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作者：
Sun, Feifei;Chen, Yixin;Li, Dongyu
背景：传统的描述和分类先天性二尖瓣畸形的方法往往缺乏特异性和科学性。方法：436例患者(平均年龄36.6+/-26.8岁，男性47.9%)接受了CMVM的超声心动图检查。应用四层超声心动图(FTEA)方法对瓣膜的特征进行了研究和分析：(1)瓣膜上区和瓣环，(2)瓣叶和瓣膜连合，(3)脉络膜，(4)乳头肌。结果：在246,507例超声心动图中，436例(0.18%)患者的超声心动图得到了系统的诊断。其中16例(3.7%)合并多节段畸形，133例(30.5%)合并其他心脏畸形。采用FTEA方法，受累范围如下：(1)瓣膜上区和瓣环(n=7[1.6%]；瓣膜上组织过多，3；异常环状，4[压倒，1；移位，2；桥接/绳索样副组织，11)；(2)瓣膜小叶和联合(n 421[96.3%]；长或过长，210；发育不全，35；收缩，12；闭锁，3；连接异常，1；疏松或隆起，63；裂隙，57；双口，5；局限性隆起，6；副组织成分，4；纤维组织，18；融合小叶尖3例；异常连合4例[融合1例；裂隙31例]；(3)肌腱索14例(32%)，局限于单个乳头肌4例；肥大2例；增厚融合2例；变短2例；纤维化2例；副组织成分1例；跨位1例；乳头肌4例(3.0%)；缺失2例；单一5例；不对称2例；位置异常3例；纤维化1例。根据这份报告，在100例CMVM患者中，无经验组(A组和B组)和有经验组(C组)逐一比较，使用常规诊断方法的无经验组A组的得分为76+/-12，使用FTEA方法的无经验组B组的得分为85+/-11，B组的得分显著高于A组(均P<0.05)。结论：详细的增量FTEA方法系统地明确了MV装置的畸形，确保了更准确的诊断成像。临床随机对照试验结果证实，FTEA对CMVMS的诊断准确率高于常规方法。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Traditional methods of describing and classifying congenital mitral valve malformations (CMVMs) often lack specificity and scientificity. Thus, documentation is incomplete, especially in terms of ultrasound findings.Methods: Data were collected from 436 patients (mean age, 36.6 +/- 26.8 years; male 47.9%), each subjected to echo cardiographic evaluation of CMVM. Valvar characteristics were studied and analyzed via a four-tiered echocardiographic analysis (FTEA) approach: (1) supravalvular region and annulus, (2) valvar leaflets and commissures, (3) chorclae tendineae, and (4) papillary muscles. A clinical random ultrasonic reacting controlled trial was designed to the compare conventional diagnostic method and FTEA in patients with CMVMs.Results: From a total of 246,507 echocardiograms, CMVMs were methodically investigated in 436 (0.18%) patients. Of these, 16 (3.7%) had multi-level malformations; and in 133 (30.5%), CVCMs were associated with other cardiac defects. Using a FTEA approach, involvement was distributed as follows: (1) supravalvular region and annulus (n = 7 [1.6%]; excessive supravalvular tissue, 3; abnormal annulus, 4 [overriding, 1; shifted, 2; bridging/cord-like accessory tissue, 11); (2) valvar leaflets and commissures (n 421 [96.3%]; lengthy or excessive, 210; underdeveloped, 35; contracture,12; atretic, 3; anomalously connected, 1; loose or billowy, 63; clefts, 57; dual orifice, 5; localized bulging, 6; accessory tissue element, 4; fibrotic, 18; fused leaflet cusps, 3; abnormal commissures, 4 [fused, 1; clefts, 31); (3) chordae tendineae (n 14 [32%]; confined to single papillary muscle, 4; excessive, 2; thickened and fused, 2; shortened, 2; fibrotic, 2; accessory tissue element, 1; straddling, 1); and (4) papillary muscles (n 13 [3.0%]; absent, 2; single, 5; asymmetric, 2; abnormally located, 3; fibrotic, 1). According to the report comparing one by one each section among the inexperienced (groups A and B) and experienced (group C) groups out of 100 patients with CMVMs, group A of the inexperienced group using the conventional diagnostic method had a score of 76 +/- 12, while group B of the inexperienced group using the FTEA method had a score of 85 +/- 11; group B scored significantly higher than group A (all P < 0.05).Conclusions: Detailed incremental FTEA method in a systematic manner clearly defines malformations of the MV apparatus, ensuring more accurate diagnostic imaging. The results of clinical randomized controlled trials confirm that FTEA diagnostic accuracy was higher than conventional methods in CMVMs. (C) 2016 Elsevier Ireland Ltd. All rights reserved.