实时三维超声心动图评价风湿性二尖瓣狭窄瓣口面积的初步探讨

目的　探讨实时三维超声心动图评价二尖瓣狭窄瓣口面积的可行性和准确性。方法　分别应用二维超声平面法、多普勒压差降半时间法和实时三维容积法检测 18例风湿性二尖瓣狭窄患者的二尖瓣瓣口面积 ,并和 3 4例正常人对照。结果　分别在二尖瓣狭窄组和对照组内 ,二维平面法、压差降半时间法与实时三维容积法测量的二尖瓣口面积均呈高度相关 (二尖瓣狭窄组 :r =0 .98,r =0 .89;正常组 :r =0 .94,r =0 .91) ;三维容积法测得的瓣口面积在正常组与二尖瓣狭窄组之间差异有显著性意义 (P <0 .0 0 0 1) ;经三维容积法测得的瓣口面积略小于二维法 (二尖瓣狭窄组 :1.3 1cm2 对 1.40cm2 ;正常组 :4.63cm2 对 4.76cm2 )。结论　实时三维超声心动图能实时显示二尖瓣口的整体形态 ,同时更容易快速切取到瓣口最小面积平面 ,可准确反映瓣膜狭窄的真实程度 ,为临床诊断和治疗提供一种新的定量分析方法。

Preliminary study of real-time three-dimensional echocardiography in quantification mitral valve area in patients with mitral stenosis

Objective To assess the feasibility and accuracy of real-time three-dimensional echocardiography (RT-3DE) for the quantification of mitral valve area (MVA) in patients with mitral stenosis (MS).Methods In 18 patients with MS,MVA was calculated by 2-dimensional echocardiography (2DE),pressure half-time (PHT) method and volumetric RT-3DE, and compared with measurements obtained from 34 normal controls.Results MVA in patients with MS measured by RT-3DE correlated well with MVA by 2DE ( r = 0.98 ) and by PHT ( r = 0.94 ),MVA in normal controls measured by RT-3DE correlated well with MVA by 2DE ( r = 0.89 ) and by PHT ( r = 0.91 );Meanwhile,MVA by RT-3DE was slightly lower than that derived from normal groups (MS group: 1.31 cm 2 vs 1.42 cm 2; normal group: 4.63 cm 2 vs 4.76 cm 2).Conclusions RT-3DE system could not only provide vivid anatomic structure of mitral valve apparatus,but also is easy to acquire the optimal plane of the smallest MVA oricle and accurately measure MVA as a qualitative way for clinical diagnosis and treatment.