二尖瓣双病变和联合瓣膜病变二尖瓣口面积的测定

目的∶探讨二尖瓣双病变和联合瓣膜病变二尖瓣口面积（ＭＶＡ）的准确测定方法。材料与方法∶分别用二维超声（２ＤＥ）、压差减半时间（ＰＨＴ）、彩色多普勒二尖瓣口血流截面积（ＣＤＦ）和椭圆形面积法（ＣＤＪ）测定４３ 例风湿性心脏病二尖瓣狭窄（ＭＳ）拟行人工瓣置换术患者的ＭＶＡ，其中合并主动脉瓣反流（ＭＳ＋ ＡＲ） １０ 例，合并二尖瓣反流（ＭＳ＋ ＭＲ） １２ 例，（ＭＳ＋ ＭＲ＋ ＡＲ） ２１ 例，并与手术标本的实测面积（ＯＰ）相比较。结果∶ＣＤＦ法三组均为高度相关；２ＤＥ法ＭＳ＋ ＡＲ组为良好相关，其余两组亦为高度相关；ＰＨＴ法三组虽为高度相关，但在ＭＳ＋ ＭＲ和ＭＳ＋ ＭＲ＋ ＡＲ组显著低估了ＯＰ；ＣＤＪ法三组均显著低估了ＯＰ。结论∶二尖瓣狭窄合并二尖瓣反流或同时并主动脉瓣反流但以二尖瓣反流显著时，ＰＨＴ法明显低估了二尖瓣口面积，而此时应用ＣＤＦＩ测量二尖瓣口血流截面积却不失为一种新的简便而较为准确的定量二尖瓣狭窄的方法，临床上值得推广。

Quantification of mitral valve area in mixed mitral valve lesions and combined with aortic valve lesions

Purpose: To quantify mitral valve area (MVA) in mixed mitral valve lesions and combined with aortic valve lesions.Methods:43 patients including 10 with mitral stenosis associated aortic regurgitation(MS AR), 12 with mixed mitral valve lesions (MS MR) and 21 with mixed mitral valve lesions and combined with aortic regurgitation (MS MR AR) were studied.MVA determinded by (1) two dimensional echocardiography with a cross sectional area in the short axis view (2DE), (2) pressure half time using formula of 220/PHT (PHT), (3) color Doppler flow imaging (CDFI) with a jet cross sectional area in the short axis view with planimetry (CDF), (4) CDFI with a color jet width at the mitral valve orifice in the apical four chamber view and long axis view, assuming an elliptic mitral orifice (CDJ), compared with the orifice area of excised mitral valve during mitral valve replacement (OP).Results:CDF showed excellent correlations with OP for all subgroups.2DE had a fair correlation for MS AR subgroup and good correlations for other subgroups.PHT correlated well with OP for all subgroups, but showed significant underestimates for MS MR ( P <0.05) and MS MR AR ( P <0.01) subgroups, respectively.CDJ underestimated OP for all subgroups.Conclusion:PHT might underestimate significantly MVA in patients with mixed mitral valve lesions or coexisted AR with MR predominant and in such cases, CDF could quantify MVA accurately.