3-DIMENSIONAL ECHOCARDIOGRAPHIC RECONSTRUCTION OF THE MITRAL-VALVE, WITH IMPLICATIONS FOR THE DIAGNOSIS OF MITRAL-VALVE PROLAPSE
3-DIMENSIONAL ECHOCARDIOGRAPHIC RECONSTRUCTION OF THE MITRAL-VALVE, WITH IMPLICATIONS FOR THE DIAGNOSIS OF MITRAL-VALVE PROLAPSE
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DOI：
10.1161/01.cir.80.3.589
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发表时间：
1989-09-01
期刊：
影响因子：
37.8
通讯作者：
WEYMAN, AE
中科院分区：
文献类型：
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作者：
LEVINE, RA;HANDSCHUMACHER, MD;WEYMAN, AE
二尖瓣脱垂的二维超声心动图诊断标准在普通人群中以惊人的频率被诊断出来，即使是在预先选择的正常受试者进行检查时也是如此。然而，在这些人中，大多数人在心尖四腔切面出现脱垂，在大致垂直的长轴切面上没有脱垂。先前对非平面环的体外模型的研究表明，收缩期二尖瓣环的非平面性可能会导致这种差异。然而，要直接证明二维观上的瓣叶表面位移不构成三维瓣环以上的真实位移，需要重建整个二尖瓣，包括瓣叶和瓣环。这种重建对于探索瓣膜的复杂几何形状和得出上叶位移的体积测量也是必要的。因此，开发了一种技术，并在体外验证了对整个二尖瓣的三维重建。在这项技术中，通过同时实时采集图像及其空间位置，可以最大限度地减少患者运动和呼吸的影响，从而重建局部结构。通过对15名正常受试者应用这种方法，可以从相交扫描中重建出二尖瓣的相干表面。结果证实了二尖瓣环在收缩时的非平面性，最大偏差为1.4+-。距平面度0.3厘米。它们直接显示，在心尖四腔切面，瓣叶可以看起来上升到二尖瓣环上方，就像在所有受试者的至少一个切面上所做的那样，而在三维上没有整个二尖瓣上方的实际瓣叶移位，从而质疑在其他正常个体中通过孤立的四腔切面移位来诊断脱垂。这项技术使我们能够以高分辨率解决一个独特的三维问题，并提供以前从二维图像中无法获得的新信息。这种新的认识应该会增强我们提出适当的临床问题的能力，将二尖瓣形状和瓣叶移位与临床和病理结果联系起来。
Mitral valve prolapse has been diagnosed by two-dimensional echocardiographic criteria with surprising frequency in the general population, even when preselected normal subjects are examined. In most of these individuals, however, prolapse appears in the apical four-chamber view and is absent in roughly orthogonal long-axis views. Previous studies of in vitro models with nonplanar rings have shown that systolic mitral annular nonplanarity can potentially produce this discrepancy. However, to prove directly that apparent leaflet displacement in a two-dimensional view does not constitute true displacement above the three-dimensional annulus requires reconstruction of the entire mitral valve, including leaflets and annulus. Such reconstruction would also be necessary to explore the complex geometry of the valve and to derive volumetric measures of superior leaflet displacement. A technique was therefore developed and validated in vitro for three-dimensional reconstruction of the entire mitral valve. In this technique, simultaneous real-time acquisition of images and their spatial locations permits reconstruction of a localized structure by minimizing the effects of patient motion and respiration. By applying this method to 15 normal subjects, a coherent mitral valve surface could be reconstructed from intersecting scans. The results confirm mitral annular nonplanarity in systole, with a maximum deviation of 1.4 .+-. 0.3 cm from planarity. They directly show that leaflets can appear to ascend above the mitral annulus in the apical four-chamber view, as they did in at least one view in all subjects, without actual leaflet displacement above the entire mitral valve in three dimensions, thereby challenging the diagnosis of prolapse by isolated four-chamber view displacement in otherwise normal individuals. This technique allows us to address a uniquely three-dimensional problem with high resolution and provide new information previously unavailable from the two-dimensional images. This new appreciation should enhnce our ability to ask appropriate clinical questions relating mitral valve shape and leaflet displacement to clinical and pathologic consequences.