上海交通大学学报(医学版)

• 论著(临床研究) • 上一篇    下一篇

成形术对二尖瓣三维结构的形态学影响

陈家飞 1,张卫 1,石暐 1,马文锐 1,叶伟 1,吴卫华 2   

  1. 上海交通大学附属胸科医院1. 心血管外科,2. 超声科,上海 200030
  • 出版日期:2017-03-28 发布日期:2017-03-30
  • 通讯作者: 张卫,电子信箱:zwyyy33@sina.com。
  • 作者简介:陈家飞(1990—),男,硕士生;电子信箱:doctorchon@sina.com。
  • 基金资助:

    上海市胸科医院科技发展基金(YZ2015-ZX03,2014YZDH10302,2014YZDH10301);上海市卫生和计划生育委员会科研课题(201540309)

Morphological changes of mitral valve geometry caused by repair procedure

CHEN Jia-fei1, ZHANG Wei1, SHI Wei1, MA Wen-rui1, YE Wei1, WU Wei-hua2   

  1. 1. Department of Cardiovascular Surgery, 2. Department of Echography, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Online:2017-03-28 Published:2017-03-30
  • Supported by:

    Shanghai Chest Hospital Science and Technology Development Funds, YZ2015-ZX03, 2014YZDH10302, 2014YZDH10301; Scientific Research Project of Shanghai Health and Family Planning Commission, 201540309

摘要:

目的 ·利用经食管实时三维超声定量评估成形术对二尖瓣三维结构的形态学影响。方法 ·收集36例二尖瓣脱垂手术组患者瓣膜成形前后及56例对照组患者的三维超声资料,采集瓣环及瓣叶三维结构参数并对比分析。结果 ·术前手术组椭圆指数、非平面夹角小于对照组,其余参数大于对照组,差异有统计学意义。术后瓣环的前后径、前外后内直径、椭圆指数、最小三维周长、二维投影中的面积、最小三维面积及瓣叶的前瓣叶暴露面积、交界直径小于对照组,瓣环非平面夹角大于对照组,差异有统计学意义;其余参数与对照组比较,无明显差异。后叶人工腱索技术组与瓣叶三角形或矩形切除技术组手术前后各参数均无明显差异。结论 ·成形术可对二尖瓣功能进行满意纠治,但从形态学角度观察,术后瓣环形态并没有恢复至正常,而瓣叶的三维形态基本得到满意纠治。人工腱索技术与瓣叶三角形或矩形切除技术对后叶脱垂的形态学疗效相仿。

关键词: 二尖瓣成形术, 经食管实时三维超声, 形态学

Abstract:

Objective · To assess the morphological changes of mitral valve geometry after mitral valve repair by using real-time 3D transesophageal echocardiography. Methods · The clinical data including 3D echocardiography of 36 patients undergoing mitral valve repair for mitral valve prolapse and 56 patients without mitral valve diseases were collected. Parameters of mitral annular and leaflet geometry were acquired and analyzed. Results · The ellipse index of the two-dimensional view (E2D), and non-planar leaflet angle (θNPA) were decreased, while other parameters were increased significantly in patients with mitral valve prolapse compared with controls before mitral valve repair. After repair, patients displayed larger θNPA, and still smaller E2D. Some parameters also get smaller, such as the anterior to posterior diameter of the mitral annulus, the anterolateral to posteromedial coaptation diameter, the minimum circumference of the three-dimensional view of the annulus, the minimum area of the two-dimensional view of the annulus, the exposed area of the anterior leaflet, inter-commissural diameter. Other parameters were not changed significantly. All parameters showed no significant difference between respect group and resect group in posterior valve prolapse before and after mitral valve repair. Conclusion · The repair procedure can restore the function of the mitral valve effectively. In view of the morphology, the geometry of the mitral valve annulus is still different from the normal apparently after the mitral valve repair, but the normal morphology of the leaflets can be regained. It seems to have similar curative effect morphologically for patients with posterior leaflet prolapse to have respect or resect strategy.

Key words: mitral valve repair, real-time 3D transesophageal echocardiography, morphology