小儿二尖瓣反流瓣环三维超声形态及运动分析

目的通过三维超声心动图对二尖瓣环的形态及瓣环在心动周期中的运动进行定量分析,探讨二尖瓣环异常与反流程度的关系。方法使用与上海交通大学图像处理与模式识别研究所合作研发的二尖瓣运动分析软件(CARDIO 4D VIEW),采用人机交互方式,分析所采集的二尖瓣瓣环的三维图像,以标记二尖瓣瓣膜根部附着点为特征点的方式,重建二尖瓣瓣环的三维超声形态。选取二尖瓣瓣环最高点至最低点的距离(Dh-l)、两个最高点的距离(Dh-h)以及两个最低点的距离(Dl-l)为参数,以腹主动脉直径作为标化参数,分别对18例二尖瓣轻度反流患儿、29例中度反流患儿、7例重度反流患儿及21例正常儿童进行测量,并对舒张末期及收缩末期两个时相的参数结果使用SPSS13.0统计软件进行分析。结果正常儿童组21例和不同程度二尖瓣反流组54例患儿,二尖瓣环均呈马鞍形态,并在整个心动周期中始终保持此形态。收缩末期Dh-l值较舒张末期增大(P0.01),Dh-h值及Dl-l值较舒张末期减小(P0.01)。中度反流组、重度反流组舒张末期及收缩末期Dh-h、DI-I测值比正常组大(P0.01),而Dh-I测值则与正常组之间差异无统计学意义(P0.05);轻度反流组和正常组3项参数(Dh-h、DI-l、Dh-l,差异均无统计学意义(P0.05)。结论三维超声心动图对定量评估二尖瓣瓣环形态及运动以及患儿二尖瓣环异常及反流程度有一定意义。

Three dimensional shape and motion analyse of mitral annulus in children with mitral valve regurgitation

Objective To analyse mitral annular shape and motion throughout the cardiac cycle by quantitative three-dimensional echocardiography （3 DE） and to explore the relationship between the shape and motion of mitral annulus and the degree of mitral valve regurgitation （MR）. Methods A new mitral valve motion analysis software （CARDIO 4D VIEW） was used to proceed the mitral annulus 3-DE data set. The boundary points of the mitral annulus were extracted and the mitral annulus was reconstructed. The distance among the highest to the lowest points of mitral annulus （Dh-1）, the two highest points distance （Dh-h）, as well as the distance between the two lowest points （DI-1） were chosen for analysis. All parameters were standardized by the diameter of the abdominal aorta. Results Dh-1 in end-systolic was larger than that in end-diastolic （P 〈 0.01 ）, Dh-h value and DI-1 value were decreased at the end-systolic point compared with those at the end-diastolic point （P 〈 0.01 ）. In moderate and severe MR groups, Dh-h and DI-1 at end-dias- tolic point were longer （P 〈0.01 ） compared with those in normal group respectively, and there was no difference in Dh-1 between two groups （P 〉 0.05）. All of three parameters in children with mild regurgita- tion remained normal （P 〉 0.05）. Conclusion The abnormal three-dimensional space structure of the mi- tral annulus could lead to MR. Dh-1, Dh-h and Dl-1 as the parameters of mitral annulus structure and function measured by 3DE, could be helpful for understanding the mechanism of MR.