Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection.
Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection.
复制标题
二尖瓣环动力学的三维超声心动图分析：瓣环成形术选择的意义。
DOI：
10.1161/circulationaha.111.084483
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发表时间：
2012-09-11
期刊：
影响因子：
37.8
通讯作者：
Gorman RC
中科院分区：
文献类型：
--
作者：
Levack MM;Jassar AS;Shang EK;Vergnat M;Woo YJ;Acker MA;Jackson BM;Gorman JH 3rd;Gorman RC
柔性瓣环成形术环的支持者假设这种装置可以维持瓣环的动力学。该假设基于这样的假设：接受二尖瓣修复的患者的环形运动相对正常。我们假设二尖瓣环动力学在缺血性二尖瓣反流 (IMR) 和粘液瘤性二尖瓣反流 (MMR) 中受损。使用飞利浦 iE33 超声心动图模块和 X7-2t 探头采集 11 名正常受试者、11 名 IMR 患者和 11 名 MMR 患者的全容积 rt-3DTEE 环。使用 Tomtec Image Arena -4D-MV Assessment© - 2.1（德国慕尼黑）进行图像分析。选择收缩中期框架来使用半自动程序启动环状跟踪。连续参数及时标准化，以提供统一的收缩期和舒张期。 IMR (9.98±155 cm2) 和 MMR 环 (13.29±3.05 cm2) 的面积均大于收缩中期正常环 (7.95±1.40 cm2)。一般来说，IMR 环的动态不如对照。在 MMR 中，瓣环动力学也明显异常，二尖瓣环在收缩早期因心室压力升高而迅速扩张。在 IMR 和 MMR 中，环形动力学和解剖结构均异常。因此，用于二尖瓣修复的柔性瓣环成形术装置不太可能产生正常的瓣环动力学或正常的解剖结构。
Proponents of flexible annuloplasty rings have hypothesized that such devices maintain annular dynamics. This hypothesis is based on the supposition that annular motion is relatively normal in patients undergoing mitral valve repair. We hypothesized that mitral annular dynamics are impaired in ischemic mitral regurgitation (IMR) and myxomatous mitral regurgitation (MMR). Philips iE33 echocardiographic module and X7-2t probe were used to acquire full volume rt-3DTEE loops in 11 normal subjects, 11 patients with IMR and 11 patients with MMR. Image analysis was performed using Tomtec Image Arena -4D-MV Assessment© - 2.1 (Munich, Germany). A midsystolic frame was selected for the initiation of annular tracking using the semi-automated program. Continuous parameters were normalized in time to provide for uniform systolic and diastolic periods. Both IMR (9.98±155 cm2) and MMR annuli (13.29±3.05 cm2) were larger in area than normal annuli (7.95±1.40 cm2) at midsystole. In general, IMR annuli were less dynamic than controls. In MMR, annular dynamics were also markedly abnormal with the mitral annulus dilating rapidly in early systole in response to rising ventricular pressure. In both IMR and MMR, annular dynamics and anatomy are abnormal. Flexible annuloplasty devices used in mitral valve repair are, therefore, unlikely to result in either normal annular dynamics or normal anatomy.