实时三维经胸超声心动图测量缩流面积评价主动脉瓣反流

目的 应用实时三维经胸超声心动图(3D-TTE)测量缩流面积(VCA)评价主动脉瓣反流.方法 将56例主动脉瓣反流患者的三维测量的VCA以及二维经胸超声心动图(2D-TTE) 测量的缩流宽度与主动脉根部造影和外科手术的主动脉瓣反流程度相比较.结果 3D-TTE测得的VCA与主动脉根部造影和外科手术的主动脉瓣反流程度密切相关(r=0. 95),无明显重叠.2D-TTE测得的缩流宽度亦与主动脉根部造影和手术的主动脉瓣反流程度有很好的相关性(r=0.92),但有较多的重叠.以主动脉根部造影和外科手术为主动脉瓣反流程度的标准,三维测得的1～4度主动脉瓣反流的相应VCA分别为≤0.19 cm2,0.2～0.39 cm2,0.4～0.59 cm2,≥0.6 cm2.结论 实时3D-T TE彩色多普勒能准确评价主动脉瓣反流,且和主动脉根部造影有很好的相关性.     

彩色多普勒血流会聚法测定主动脉瓣有效反流口面积的临床应用

目的　探讨彩色多普勒血流会聚法在主动脉瓣反流定量诊断中的临床应用价值。方法　选择近端血流会聚角呈水平型的单纯性主动脉瓣反流患者 48例 ,分别应用血流会聚法和常规多普勒超声法测量有效反流口面积 (ERO)。结果　血流会聚法和多普勒超声法测定的ERO分别为 (0 .3 2± 0 .17)cm2 和 (0 .3 3± 0 .16)cm2 (P >0 .0 5 ) ,二者之间存在极好的相关性 (Y =0 .99X -0 .0 1,r =0 .97,P <0 .0 0 0 1)。结论　在近端血流会聚角为水平型的主动脉瓣反流患者 ,血流会聚法能够准确地测量ERO ,是一种简便、实用的定量主动脉瓣反流程度的新方法     

不同短轴切面的面积变化分数的研究

胸骨旁左室短轴乳头肌水平切面的面积变化分数与射血分数呈高度相关,但对其他切面的面积变化分数却少有研究。对25例心功能正常者,选择二维超声心动图各左室短轴切面,应用手动描迹球法与声学定量技术分别计算各相应切面的面积变化分数。结果:手动描迹球法及声学定量技术测得各短轴切面的面积变化分数均呈高度相关(r=0.88～0.96);各切面面积变化分数测值无显著差异(P>0.05)。结论:声学定量技术与手动描迹球法测量的面积变化分数相关良好;左室收缩功能正常者不同左室短轴切面的面积变化分数相同。     

应用彩色多普勒自动测量房间隔缺损分流量的临床评价

目的应用彩色多普勒自动测量心输出量功能(Automated Cardiac Flow Measurement,ACM)测量房间隔缺损分流量,并评价其临床应用价值.方法分别应用ACM直接法,ACM间接法与脉冲多普勒法测量40例经手术证实的房间隔缺损患者的分流量,并与手术中测量的缺损径对比.结果ACM直接法测量的分流量与ACM间接法及脉冲多普勒法测量结果之间有显著性差异,并与手术测量缺损径间呈直线相关(r＝0.83,P＜0.001).结论ACM为定量评价房间隔缺损分流量提供了一种简单、快速、精确的新的测量方法.     

瓣环扩大在功能性二尖瓣返流机制中的作用

目的探讨瓣环扩大在功能性二尖瓣返流机制中的作用。方法应用超声心动图检查房颤组(20例)、返流组(30例)及正常组(20例)的心脏,测量二尖瓣返流比例、左室射血分数(EF)、左室大小、球形度、收缩期瓣环(MA)面积、收缩期后乳头肌与二尖瓣前瓣环的距离(PPMAMA)。结果房颤组左室大小、球形度、EF、PPMAMA和正常组相比没有统计学差异,但收缩期MA面积较正常组明显扩大,并与返流组相似,分别为(5.3±1.1)cm2、(7.4±1.5)cm2、(8.0±2.0)cm2,但房颤组二尖瓣返流量明显小于功能性二尖瓣返流组,分别为(12±7)%和(30±14)%。结论单纯瓣环的扩张似乎并不引起中或重度二尖瓣返流。     

手描法与声学定量技术对超声心动图左室短轴不同切面面积变化分数的对比研究

目的 对比研究手描法和声学定量技术对二维超声心动图左室短轴不同切面的面积变化分数。方法 用手动轨迹球法和声学定量技术对30例二维超声心动图不同左室短轴切面的面积变化分数进行比较研究。结果左室功能正常者，左室不同短轴切面的面积变化分数相近，两法测量的面积变化分数相关良好。结论 声学定量技术和手描法测得的不同左室短轴切面的面积变化分数有很好的相关性。     

彩色多普勒血流会聚与众射流参数在二尖瓣返流定量中的价值

用血流会聚新方法及射流参数对二尖瓣返流定量的价值进行了研究。结果表明血流会聚法计算返流量与二尖瓣返流容积及返流分数相关性最佳。彩色多普勒射流参数与二尖瓣返流容积和二尖瓣返流分数的相关性不一，其中返流起始宽度与两者相关性分别为ｒ＝０．８７－０．９３，Ｐ＜０．０００１）．彩色多普勒射流参数与二尖瓣返流容积和二尖瓣返流分数的相关性不一，其中返流起始宽度与两者相关性分别为ｒ＝０．８８和０．８１（Ｐ＜０．０     

彩色多普勒血流会聚法定量二尖瓣返流的临床应用

为在临床上应用彩色多普勒血流会聚法定量评价二尖瓣返流，本文应用频谱多普勒法评估二尖瓣返流作对照，评价其定量返流的临床应用价值，文中研究了２４例二尖瓣返流患者，用二维超声心动图计算出主动脉瓣口和二尖瓣口的面积，用频谱多普勒计算出收缩期主动脉瓣口血流的速...     

主动脉瓣反流的定量评估:实时三维彩色多普勒血流成像与MRI对照研究

目的探讨实时三维彩色多普勒血流成像(RT-3DCDFI)定量评估主动脉瓣反流的价值。方法选取17例单纯性主动脉瓣反流。实时三维超声心动图采集全容积数据库和三维彩色血流信号数据库,导入TomTec三维图像工作站脱机测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)和主动脉瓣彩色反流束容积(RJV),并计算左室每搏量(LVSV)和RJV/LVSV(%)。MRI测量LVEDV、LVESV和RJV,并计算LVSV和RJV/LVSV(%)。RT-3DCDFI和MRI的测值行相关性分析。结果RT-3DCDFI和MRI评价主动脉瓣反流的测值相关性良好,其中RJV测值相关性为r=0.92,Y=0.88X 3.32,P<0.0001,二者间的均数差为-2.0ml,标准差为9.5ml;RJV/LVSV(%)测值的相关性为r=0.88,Y=1.16X-10.74,P<0.0001,二者间的均数差为-2.8%,标准差为7.9%。结论RT-3DCDFI可对主动脉瓣反流进行准确定量评估,为临床评价主动脉瓣反流提供了一种简便、可靠的新方法。     

彩色多普勒血流显像的三维重建定量评价心脏瓣膜返流—瓣口形态和混叠速度对返流容积的影响

本研究采用体外血流模型实验评价三维（3D）超声重建的方法定量瓣膜返流的大小，并与二维（2D）彩色血流显像对照。实验中选择三种返流瓣口（圆形、矩形和三角形）。仪器使用InterspeApogee彩色多普勒超声仪，探头附着在一种机械臂上，在TomTec计算机控制下进行0°至180°的旋转扫描获得三维重建的数据。结果示：2D彩色多普勒血流显像的最大面积与实际返流容积和最大返流量呈中等度相关（r=0．84和0．81）。3D重建后的返流容积与实际测定的返流容积（ml／beat）和最大返流量（L／min）相关良好（r=0．92和0．88）；当分别测定单瓣口重建的返流容积时，其结果与实际返流容积相关更好（圆形，r=0．96；矩形，r=0．99及三角形，r=0．99）。结论：尽管3D重建返流容积的大小同样受混叠速度、瓣口形状的影响，但3D重建与实际返流量对照研究的结果仍明显优于2D彩色血流面积法，说明3D重建是定量评价瓣膜反流较准确的方法。     

Quantitative analysis of aortic regurgitation: real-time 3-dimensional and 2-dimensional color Doppler echocardiographic method--a clinical and a chronic animal study.

BACKGROUND: For evaluating patients with aortic regurgitation (AR), regurgitant volumes, left ventricular (LV) stroke volumes (SV), and absolute LV volumes are valuable indices. AIM: The aim of this study was to validate the combination of real-time 3-dimensional echocardiography (3DE) and semiautomated digital color Doppler cardiac flow measurement (ACM) for quantifying absolute LV volumes, LVSV, and AR volumes using an animal model of chronic AR and to investigate its clinical applicability. METHODS: In 8 sheep, a total of 26 hemodynamic states were obtained pharmacologically 20 weeks after the aortic valve noncoronary (n = 4) or right coronary (n = 4) leaflet was incised to produce AR. Reference standard LVSV and AR volume were determined using the electromagnetic flow method (EM). Simultaneous epicardial real-time 3DE studies were performed to obtain LV end-diastolic volumes (LVEDV), end-systolic volumes (LVESV), and LVSV by subtracting LVESV from LVEDV. Simultaneous ACM was performed to obtain LVSV and transmitral flows; AR volume was calculated by subtracting transmitral flow volume from LVSV. In a total of 19 patients with AR, real-time 3DE and ACM were used to obtain LVSVs and these were compared with each other. RESULTS: A strong relationship was found between LVSV derived from EM and those from the real-time 3DE (r = 0.93, P <.001, mean difference (3D - EM) = -1.0 +/- 9.8 mL). A good relationship between LVSV and AR volumes derived from EM and those by ACM was found (r = 0.88, P <.001). A good relationship between LVSV derived from real-time 3DE and that from ACM was observed (r = 0.73, P <.01, mean difference = 2.5 +/- 7.9 mL). In patients, a good relationship between LVSV obtained by real-time 3DE and ACM was found (r = 0.90, P <.001, mean difference = 0.6 +/- 9.8 mL). CONCLUSION: The combination of ACM and real-time 3DE for quantifying LV volumes, LVSV, and AR volumes was validated by the chronic animal study and was shown to be clinically applicable.     

Quantification of regurgitant lesions by MRI

We examined 46 patients with angiographically documented regurgitant lesions (26 patients with mitral regurgitation, 20 patients with aortic regurgitation) using an 0.5 Tesla magnet. In each patient a multislice-multiphase spinecho sequence in sagittal-coronal double angulated plane was performed to assess left and right ventricular volumes, ejection fraction and regurgitant fraction. Additionally a blood flow sensitive gradient echo technique was done to visualize direction and extension of the regurgitant jet. MRI data were compared with quantitative and qualitative assessment of regurgitation by angiography and echocardiography. Using the gradient echo technique MRI could demonstrate the regurgitant jet in all patients. A linear correlation for volume parameters by MRI and angio was found with best correlation for the left ventricular stroke volume (r=0.82, p<0.0001). Furthermore MRI regurgitant fraction correlated with angiographically determined regurgitant fraction in patients with aortic regurgitation (r=0.91, p<0.0001) and mitral regurgitation (r=0.67, p<0.001), respectively. Semiquantitative assessment of regurgitation by gradient echo technique showed an agreement with angiographic grading by Sellers in 70% of mitral and 75% of aortic regurgitation, respectively. The comparison of MRI and color Doppler sonography showed only moderate correlation of r=0.72 (p<0.01).     

实时三维超声心动图观察兔室壁瘤形成过程的形态学特征

目的 应用实时三维超声心动图观察兔心肌梗死后不同时间段室壁瘤形成的形态学特征。方法 选取新西兰白兔20只,采用结扎左前降支中段及左旋支中段制作室壁瘤模型。普通饮食饲养4周后,将仍存活且有室壁瘤形成的实验动物纳入本研究,按照不同观察时间点分为术前、术后1天、2天、3天、1周、2周、3周、4周,并于术前及术后各时间点行二维超声心动图及实时三维超声心动图检查,并获取左心室射血分数、左心室舒张末期容积、左心室收缩末期容积、室壁瘤容积、左心室舒张末期内径、左心室短轴缩短率、左心室舒张末期左心室前壁厚度。结果 术后2天兔室壁瘤开始形成,术后3周基本形成,室壁瘤形成只数于术后2天至术后3周随时间呈增加趋势。与术前、术后1天比较,左心室收缩和舒张末期容积、左心室舒张末期内径及室壁瘤容积于术后2天至术后3周呈增加趋势(P<0.05),左心室前壁厚度、短轴缩短率及射血分数于术后2天至术后3周呈下降趋势(P<0.05),术后3周后趋于稳定。室壁瘤容积、室壁瘤容积占左心室舒张末期容积百分比与射血分数有较好的相关性(r=-0.778、-0.911,P均<0.001)。结论 室壁瘤容积与左心室舒张末期容积的百分比可作为评价兔心功能的重要参数。     

彩色多普勒血流会聚法评估偏心性二尖瓣返流的临床价值

观察３０列显示血流会聚区的偏心性二尖瓣返流患者的返流束形态，发现均为附壁细长束。返流束面积、返流束面积／左房面积与频谱多普勒法及血流会聚法测定的参数比较左相关性均较差，相关系数分别为０．５９、０．５６及０．５５、０．５７，耐血流会聚法所测返流率与频谱多普勒法所测返流量则高度相关，相关系数为０．９６（Ｐ＜０．０１）。     

Quantification of aortic regurgitation by real-time 3-dimensional echocardiography in a chronic animal model: computation of aortic regurgitant volume as the difference between left and right ventricular stroke volumes.

BACKGROUND: The accuracy of conventional 2-dimensional echocardiographic and Doppler techniques for the quantification of valvular regurgitation remains controversial. In this study, we examined the ability of real-time 3-dimensional (RT3D) echocardiography to quantify aortic regurgitation by computing aortic regurgitant volume as the difference between 3D echocardiographic-determined left and right ventricular stroke volumes in a chronic animal model. METHODS: Three to 6 months before the study, 6 sheep underwent surgical incision of one aortic valve cusp to create aortic regurgitation. During the subsequent open chest study session, a total of 25 different steady-state hemodynamic conditions were examined. Electromagnetic (EM) flow probes were placed around the main pulmonary artery and ascending aorta and balanced against each other to provide reference right and left ventricular stroke volume (RVSV and LVSV) data. RT3D imaging was performed by epicardial placement of a matrix array transducer on the volumetric ultrasound system, originally developed at the Duke University Center for Emerging Cardiovascular Technology. During each hemodynamic steady state, the left and right ventricles were scanned in rapid succession and digitized image loops stored for subsequent measurement of end-diastolic and end-systolic volumes. Left and right ventricular stroke volumes and aortic regurgitant volumes were then calculated and compared with reference EM-derived values. RESULTS: There was good correlation between RT3D left and right ventricular stroke volumes and reference data (r = 0.83, y = 0.94x + 2.6, SEE = 9.86 mL and r = 0.63, y = 0.8x - 1.0, SEE = 5.37 mL, respectively). The resulting correlation between 3D- and EM-derived aortic regurgitant volumes was at an intermediate level between that for LVSV and that for RVSV (r = 0.80, y = 0.88x + 7.9, SEE = 10.48 mL). RT3D tended to underestimate RVSV (mean difference -4.7 +/- 5.4 mL per beat, compared with -0.03 +/- 9.7 mL per beat for the left ventricle). There was therefore a small overestimation of aortic regurgitant volume (4.7 +/- 10.4 mL per beat). CONCLUSION: Quantification of aortic regurgitation through the computation of ventricular stroke volumes by RT3D is feasible and shows good correlation with reference flow data. This method should also be applicable to the quantification of other valvular lesions or single site intracardiac shunts where a difference between right and left ventricular cavity stroke volumes is produced.     

磁共振相位编码速度标识技术在儿童二尖瓣反流定量分析中应用

目的利用磁共振相位编码速度标识技术对儿童二尖瓣反流作定量分析。方法本组二尖瓣反流组共19例,男11例,女8例。正常对照组10例,男5例,女5例。19例二尖瓣反流病人先行心脏超声检查,利用半定量方法,诊断19例二尖瓣反流,轻度反流5例,中度反流10例,重度反流4例。利用磁共振的相位编码速度标识技术分别对正常对照组、二尖瓣轻、中、重度反流的病例进行左心室流入量和主动脉流量测定,随后对所测的结果进行统计学分析。结果在正常对照组中,左心室流入量与主动脉流量之间的相关性良好。正常组与轻度二尖瓣反流反流量与反流指数无显著性差异,正常组分别与中度、重度二尖瓣反流组反流量与反流指数有显著性差异,轻、中、重度二尖瓣反流组间有显著性差异,二尖瓣反流指数与超声的二尖瓣反流程度的估计相关性良好。结论磁共振相位编码速度标识技术为非创伤检查中对儿童二尖瓣反流定量分析的较好方法,并为以后的外科手术以及术后随访提供更为精确的信息。     

实时三维彩色多普勒血流显像与磁共振定量心脏瓣膜反流束容积的对照研究

目的探讨实时三维彩色多普勒血流显像（RT-3DCDFI）技术诊断和定量评估心脏瓣膜反流的临床应用价值。方法17例主动脉瓣反流患者和11例二尖瓣反流患者,应用RT-3DCDFI采集瓣膜反流束三维彩色多普勒血流信号数据库,导入TomTec三维图像工作站脱机测量反流束容积,并与磁共振（MRI）测值对照。结果28例瓣膜反流RT-3DCDFI检查均取得满意效果,包括中心型反流19例（主动脉瓣反流12例,二尖瓣反流7例）,偏心型反流9例（主动脉瓣反流5例,二尖瓣反流4例）。RT-3DCDFI与MRI对反流束容积的测值相关性良好。全部病例组RT-3DCDFI与MRI测值相关性r=0.93,Y=0.89X＋3.39,P〈0.0001,二者间的均数差为1.7ml,标准差为8.3ml;中心型反流组RT-3DCDFI与MRI测值相关性r=0.94;偏心型反流组RT-3DCDFI与MRI测值相关性r=0.91。结论RT-3DCDFI可准确测量瓣膜反流束容积,有望为临床定量评估心脏瓣膜反流提供一种简便、准确、可靠的新方法。     

Quantitative Assessment of Chronic Aortic Regurgitation with 3-Dimensional Echocardiographic Reconstruction: Comparison with Electromagnetic Flowmeter Measurements

Two-dimensional echocardiography and color Doppler are useful in the qualitative assessment of aortic regurgitation. However, color Doppler planar methods are not accurate in quantifying regurgitant flow, in part because of the complex geometry of aortic regurgitant flow events. Three-dimensional echocardiographic reconstruction is a new technique that provides dynamic 3-dimensional images of intracardiac color flow jets. We sought to determine whether the measurement of aortic regurgitant jet volume by 3-dimensional echocardiography correlated with the true regurgitant volume, measured by electromagnetic flowmeter in vivo, to accurately reflect the severity of aortic regurgitation. We performed volume-rendered 3-dimensional echocardiography in 6 sheep with surgically induced chronic eccentric aortic regurgitation. We obtained a total of 22 aortic regurgitation states by altering loading conditions. Instantaneous regurgitant flow rates were obtained by aortic and pulmonary electromagnetic flowmeters. The maximum aortic regurgitant jet volume by 3-dimensional echocardiography and the maximum jet area by 2-dimensional echocardiography were measured and compared with electromagnetic flowmeter data. By electromagnetic flowmeter, aortic regurgitant flow rate varied from 0.14 to 3.1 L/min (mean 1.25 ± 0.78); aortic regurgitant stroke volume varied from 1 to 34 mL/beat (mean 12 ± 8), and regurgitant fraction varied from 3% to 42% (mean 25% ± 12%). The maximum jet volume by 3-dimensional echocardiography correlated very well with the aortic regurgitant stroke volume (r = 0.92; P < .0001), with the mean regurgitant flow rate (r = 0.87; P < .0001), and with the regurgitant fraction (r = 0.87; P < .0001) derived from electromagnetic flowmeter. Both intraobserver and interobserver variability on the measurement of the jet volume by 3-dimensional echocardiography were excellent (r = 0.98; P < .0001 and r = 0.90; P < .001, respectively). The maximum jet area by 2-dimensional echocardiography did not correlate with the aortic regurgitant stroke volume (r = 0.41; P = not significant) and related poorly with the regurgitant fraction (r = 0.52; P < .05) by electromagnetic flowmeter. Dynamic 3-dimensional echocardiography can allow better determination of the geometry of the aortic regurgitant jet and may assist of quantifying the severity of aortic regurgitation. (J Am Soc Echocardiogr 1999;12:138-48.)     

Usefulness of the mitral/aortic flow velocity integral ratio as a screening method to identify patients with hemodynamically significant mitral regurgitation.

OBJECTIVE: We sought to test the value of a simple Doppler index, the mitral/aortic flow velocity integral ratio (MAVIR), as a screening method to identify patients with hemodynamically significant mitral regurgitation (MR). METHODS: Included in the study were 91 patients (mean age 61 +/- 14 years; 54% men) with echocardiographically diagnosed MR. The cause was organic in 23 patients and ischemic/functional in 68. MR degree was assessed by 2 quantitative echocardiographic measures: the regurgitant fraction and the regurgitant orifice area. RESULTS: A good correlation was found between MAVIR and both regurgitant fraction (r = 0.75) and orifice (r = 0.60). When we divided patients into 3 groups on the basis of the regurgitant fraction, used as reference standard, MAVIR significantly increased in proportion to MR severity (0.7 +/- 0.1 for mild MR vs 1.1 +/- 0.2 for moderate and 1.4 +/- 0.3 for severe regurgitation; P <.0001). A ratio > 1 identified 28 of 30 patients with severe MR (regurgitant fraction > 60%), whereas all patients with mild MR (regurgitant fraction < 40%) had a ratio < 1. Using a regurgitant orifice >or= 40 mm(2) as threshold for severe MR, a significant difference in MAVIR was also present among patients who had severe MR compared with those having mild and moderate regurgitation (P <.0001). CONCLUSIONS: These findings suggest that MAVIR is a sensitive index, potentially widely applicable in clinical practice as a screening parameter for identifying patients with hemodynamically significant MR.     

动态三维超声重建定量测定主动脉瓣返流

为了评价Voxel模型动态三维超声重建定量测定主动脉瓣返流的准确性，我们对32例各种主动脉瓣关闭不全者的返流柱进行动态三维重建，对其中11例主动脉瓣返流柱的容积进行定量测定并与磁共振（MRI）对照。结果发现该技术能清晰地显示返流柱的形态及与周围结构的空间关系。返流柱的容积与MRI法测量结果的相关系数为0．91。作为半定量方法，使临床上判断返流严重程度更为精确，但对于返流柱的容积与近流程度之间的定量关系有待今后进一步研究。