Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 2: geometrical measurements in patients with functional mitral regurgitation.
Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 2: geometrical measurements in patients with functional mitral regurgitation.
复制标题
用于经导管二尖瓣介入治疗的二尖瓣复合体的定量多层计算机断层扫描评估第 2 部分：功能性二尖瓣反流患者的几何测量。
DOI：
10.4244/eijy15m11_10
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
N. Piazza
中科院分区：
文献类型：
--
作者：
P. Thériault;M. Dorfmeister;D. Mylotte;A. Andalib;M. Spaziano;P. Blanke;G. Martucci;R. Lange;J. Leipsic;L. Bilodeau;N. Piazza
旨在
经导管二尖瓣置换术（TMVR）是一项新兴技术，有可能治疗二尖瓣手术风险过高的二尖瓣返流患者。二尖瓣复合体的几何测量可能对TMVR器械的设计和患者选择有影响。本研究旨在使用多层计算机断层扫描（MSCT）量化严重功能性二尖瓣反流（FMR）患者的二尖瓣复合体的动态几何形状。
方法和结果
对32例有症状的明显FMR患者进行了MSCT成像。两名独立观察员使用专用软件包和标准测量方法分析了图像集。FMR患者的二尖瓣环连合间和室壁间直径收缩期分别为41.5±5.2 mm和38.7±5.9 mm，二尖瓣环为41.5±4.4 mm和40.0±4.7 mm。无二尖瓣返流者收缩期和舒张期的直径分别为33.6± 5.1mm和28.8± 8.0mm，舒张期分别为36.2± 4.5mm和31.6± 7.9mm。二尖瓣环下方的无障碍区平均大于20.0 mm，收缩期和舒张期之间的变化小于1 mm，无统计学显著性。二尖瓣-二尖瓣夹角收缩期为129.7±10.5°，舒张期为131.0±9.4°。
结论
FMR患者的二尖瓣环尺寸更大，更圆，动态性更低。二尖瓣环下方的无障碍区在心动周期期间相对恒定。患者之间的二尖瓣装置测量值差异很大，这表明三维成像将在TMVR器械的尺寸确定中发挥重要作用。
AIMS
Transcatheter mitral valve replacement (TMVR) is an emerging technology with the potential to treat patients with mitral regurgitation at excessive risk for mitral valve surgery. Geometrical measurements of the mitral valvular complex may have implications for the design of TMVR devices and for patient selection. This study sought to quantify the dynamic geometry of the mitral valvular complex in patients with significant functional mitral regurgitation (FMR) using multi-slice computed tomography (MSCT).
METHODS AND RESULTS
MSCT images were acquired in 32 patients with symptomatic, significant FMR. Two independent observers analysed image sets using a dedicated software package and a standard measurement methodology. In patients with FMR, the mean mitral annulus intercommissural and aorto-mural diameters were, respectively, 41.5±5.2 mm and 38.7±5.9 mm in systole, and were 41.5±4.4 mm and 40.0±4.7 mm in diastole. In patients without MR, the diameters were, respectively, 33.6±5.1 mm and 28.8±8.0 mm in systole, and 36.2±4.5 mm and 31.6±7.9 mm in diastole. The obstacle-free zone below the mitral annulus averaged more than 20.0 mm and varied by less than 1 mm between systole and diastole, which is not statistically significant. The aorto-mitral angle was 129.7±10.5° in systole and 131.0±9.4° in diastole.
CONCLUSIONS
The mitral annulus is larger in dimension, more circular, and less dynamic in patients with FMR. The obstacle-free zone below the mitral annulus is relatively constant during the cardiac cycle. Measurements of the mitral valvular apparatus vary considerably between patients, which suggests that tridimensional imaging will play an important role in the sizing of TMVR devices.