THE RELATIONSHIP OF MITRAL ANNULAR SHAPE TO THE DIAGNOSIS OF MITRAL-VALVE PROLAPSE
THE RELATIONSHIP OF MITRAL ANNULAR SHAPE TO THE DIAGNOSIS OF MITRAL-VALVE PROLAPSE
复制标题
DOI：
10.1161/01.cir.75.4.756
复制
发表时间：
1987-04-01
期刊：
影响因子：
37.8
通讯作者：
WEYMAN, AE
中科院分区：
文献类型：
--
作者：
LEVINE, RA;TRIULZI, MO;WEYMAN, AE
二尖瓣脱垂的几何学或解剖学诊断，与粘液瘤性瓣膜病的病理诊断相反，是基于二尖瓣瓣叶与周围瓣环的关系。目前超声心动图诊断标准包括在任何二维视图中瓣叶位移高于瓣环铰链点;交叉视图的等效使用隐含着二尖瓣环是欧几里得平面的假设。根据这些标准，在一般人群中发现了惊人的大比例脱垂。然而，在大多数患者中，脱垂出现在心尖四腔切面，而在左心室大致正交的长轴切面上则不存在。这种在相交视图中经常观察到的瓣叶-瓣环关系之间的差异表明二尖瓣装置的潜在几何特性，其在一个视图中会产生脱垂的外观，而没有实际的瓣叶变形。为了解决这种可能性，构建了二尖瓣和瓣环的模型。当模型瓣环为非平面鞍形构型时，再现了临床观察结果;瓣叶似乎位于一个平面中瓣环低点上方，而在垂直平面中瓣环高点下方。因此，如果二尖瓣环是非平面的，二尖瓣脱垂的出现可能在二尖瓣环的最上级点上方没有实际的瓣叶移位。 为了确定这种模式是否反映在人类二尖瓣环，二维超声心动图的意见，二尖瓣装置获得的旋转约心尖在20例患者没有明显的环形或风湿性瓣膜疾病。在所有病例中，从这些视图重建的二尖瓣环具有非平面收缩构型，高点位于前部和后部。这与其他动物组的结果一致，并且有利于在四腔视图中出现脱垂，而在前后方向的长轴视图中没有脱垂。因此，该模型可以解释在粗略正交视图中经常观察到的小叶-瓣环关系之间的差异。它挑战了二尖瓣环是平面的假设以及基于该假设的许多其他正常个体的脱垂诊断。
The geometric or anatomic diagnosis of mitral valve prolapse, as opposed to the pathologic diagnosis of myxomatous valve disease, is based on the relationship of the mitral leaflets to the surrounding anulus. Current echocardiographic criteria for this diagnosis include leaflet displacement above the annular hinge points in any two-dimensional view; implicit in this equivalent use of intersecting views is the assumption that the mitral anulus is a euclidean plane. Prolapse by these criteria is found in a surprising large proportion of the general population. In most of these individuals, however, prolapse is present in the apical four-chamber view and absent in roughly orthogonal long-axis views of the left ventricle. This frequently observed discrepancy between leaflet-annular relationships in intersecting views suggests an underlying geometric property of the mitral apparatus that would produce the appearance of prolapse in one view without actual leaflet distortion. To address this possibility, a model of the mitral valve and anulus was constructed. When the model anulus was given a nonplanar, saddle-shaped configuration, the clinical observations were reproduced; the leaflets appeared to lie above the low points of the anulus in one plane, and below its high points in a perpendicular plane. Therefore, the appearance of mitral valve prolapse can occur without actual leaflet displacement above the most superior points of the mitral anulus if the anulus is nonplanar. To determine whether this pattern is reflected in the human mitral anulus, two-dimensional echocardiographic views of the mitral apparatus were obtained by rotation about the cardiac apex in 20 patients without evident annular or rheumatic valvular disease. In all cases the mitral anulus, as reconstructed from these views, had a nonplanar systolic configuration, with high point located anteriorly and posteriorly. This is consistent with the findings of other groups in animals, and would favor the appearance of prolapse in the four-chamber view and its absence in long-axis views that are oriented anterioposteriorly. This model can therefore explain the frequently observed discrepancy between leaflet-annular relationships in roughtly orthogonal views. It challenges the assumption that the mitral anulus is planar as well as the diagnosis of prolapse in many otherwise normal individuals based on that assumption.