Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve
Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve
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DOI：
10.1016/s0002-8703(00)90077-2
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发表时间：
2000-03-01
影响因子：
4.8
通讯作者：
Martin, RW
中科院分区：
文献类型：
--
作者：
Kaplan, SR;Bashein, G;Martin, RW
目的 比较正常心脏患者与功能性二尖瓣反流 (FMR) 患者在整个心动周期中二尖瓣环的形状和运动。 背景 无瓣膜疾病的二尖瓣反流的原因尚不清楚，但这种情况与环形状和动力学的变化有关。三维 (3D) 成像提供了更全面的环形结构视图，并允许以高空间和时间分辨率进行精确重建。方法 对 9 名正常受试者和 8 名接受手术的 FMR 患者进行旋转扫描经食管超声心动图检查。在 1 个窦性搏动的每个视频帧中，通过傅立叶级数以 3D 方式手动追踪和重建二尖瓣环。在收缩期的 10 个时间点和舒张期的 10 个时间点测定瓣环投影面积、非平面度、偏心率、周长以及峰间和峰间跨度。结果 FMR 患者的二尖瓣环群比正常受试者具有更大的面积、周长和峰间跨度（所有 P < .001）。在正常环的收缩中期，面积和周长达到最小值，非平面性最大，并且投影形状最小为圆形。这些周期性变化在 FMR 患者中并不显着。所有患者的瓣环面积变化与周长变化密切相关（平均值 r = 0.96 +/- 0.07）。 结论 FMR 与瓣环扩张以及瓣环形状和面积的周期性变化减少相关。正常的二尖瓣功能可能取决于正常的环形 3D 形状和尺寸以及环形可塑性。这些观察结果可能对二尖瓣环假体的设计和选择有影响。
Objectives To compare mitral annular shape and motion throughout the cardiac cycle in patients with normal hearts versus those with functional mitral regurgitation (FMR).Background The causes of mitral regurgitation without valvular disease are unclear, but the condition is associated with changes in annular shape and dynamics. Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions at high spatial and temporal resolution.Methods Nine normal subjects and 8 patients with FMR undergoing surgery underwent rotationally scanned transesophageal echocardiography. At every video frame of 1 sinus beat, the mitral annulus was manually traced and reconstructed in 3D by Fourier series. Annular projected area, nonplanarity, eccentricity, perimeter length, and interpeak and intervalley spans were determined at 10 time points in systole and 10 points in diastole.Results The mitral annulus in patients with FMR herd a larger area, perimeter, and interpeak span than in normal subjects (P < .001 for all). At mid-systole in normal annuli, area and perimeter reach a minimum, nonplanarity is greatest, and projected shape is least circular. These cyclic variations were not significant in patients with FMR. Annular area change closely paralleled perimeter change in all patients (mean r = 0.96 +/- 0.07).Conclusions FMR is associated with annular dilation and reduced cyclic variation in annular shape and area. Normal mitral valve function may depend on normal annular 3D shape and dimensions as well as annular plasticity. These observations may have implications for design and selection of mitral annular prostheses.