二尖瓣狭窄区域的超声心动图评估：新型三维方法与常规技术的比较
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Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques
背景与目的
二尖瓣狭窄（MS）严重程度的综合评估通常采用二维（2D）超声心动图技术。然而，二尖瓣（MV）复杂的三维结构对2D成像模型测量孔径面积的精确度造成挑战。我们旨在通过将常规超声心动图方法测量的MV孔径面积的测量值与3D孔径面积（3DOA）进行比较来评估MS严重程度，该3D孔径区域（3DOA）是一项最小化几何设定的新型超声心动图技术二尖瓣狭窄（MS）严重程度的综合评估通常采用二维（2D）超声心动图技术。然而，二尖瓣（MV）复杂的三维结构对2D成像模型测量孔径面积的精确度造成挑战。我们旨在通过将常规超声心动图方法测量的MV孔径面积的测量值与3D孔径面积（3DOA）进行比较来评估MS严重程度，该3D孔径区域（3DOA）是一项最小化几何设定的新型超声心动图技术。
方 法
在26例至少有中度风湿性MS的成年心脏手术患者进行系统性回顾。术中常规进行2D和3D经食管超声心动图，将测量的压力减半时间（PHT），近端等速表面积（PISA），连续性方程和3D平面测量获得的MV孔径面积与使用3DOA获得的MV孔径积进行比较。
结 果
通过PHT，PISA，连续性方程，3D平面测量和3DOA（平均值±标准差）得出的MV区域面积分别为1.12±0.27,1.03±0.27,1.16±0.35，0.97±0.25和0.76±0.21 cm 2。从3DOA方法获得的面积显着小于从PHT得到的面积（平均差0.35 cm 2，P <0.0001），PISA（平均差：0.28 cm 2，P = 0.0002），连续性方程（平均差：0.43 cm 2，P = .0015）和3D平面测量（平均差：0.19cm 2，P <0.0001）。MV 3DOAs与PHT（31％，P = .006），PISA（42％，P = 0.01）和连续性方程（39％，P = 0.017）相比能显著发现更多比率的严重MS患者（88%），而与3D平面测量相比不明显（62％，P = .165）。
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结 论
风湿性心脏病患者的MV 3DOA的新方法测量的孔径值显著小于通过常规方法获得的测量值，并且与2D技术相比可能与严重MS的发生率更加一致。 需要进一步调查来帮助确定3D超声心动图技术用于测量MV面积的临床相关性。
原始文献摘要
Karamnov S, Burbano-Vera N, Huang C C, et al. Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques[J]. Anesthesia & Analgesia, 2017, 376(23):1.
BACKGROUND:A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizes two-dimensional (2D) echocardiography techniques. However, the complex three-dimensional (3D) structure of the mitral valve (MV) poses challenges to accurate measurements of its orifice area by 2D imaging modalities. We aimed to assess MS severity by comparing measurements of the MV orifice area using conventional echocardiography methods to 3D orifice area (3DOA), a novel echocardiographic technique which minimizes geometric assumptions.
METHODS: Routine 2D and 3D intraoperative transesophageal echocardiographic images from 26 adult cardiac surgery patients with at least moderate rheumatic MS were retrospectively reviewed. Measurements of the MV orifice area obtained by pressure half-time (PHT), proximal isovelocity surface area (PISA), continuity equation, and 3D planimetry were compared to those acquired using 3DOA.
RESULTS:MV areas derived by PHT, PISA, continuity equation, 3D planimetry, and 3DOA (mean value ± standard deviation) were 1.12 ± 0.27, 1.03 ± 0.27, 1.16 ± 0.35, 0.97 ± 0.25, and 0.76 ± 0.21 cm 2 , respectively. Areas obtained from the 3DOA method were significantly smaller than areas derived from PHT (mean difference 0.35 cm 2 , P < .0001), PISA (mean difference: 0.28 cm 2 , P = .0002), continuity equation (mean difference: 0.43 cm 2 , P = .0015), and 3D planimetry (mean difference: 0.19 cm 2 , P < .0001). MV 3DOAs also identified a significantly greater percentage of patients with severe MS (88%) compared to PHT (31%, P = .006), PISA(42%, P = .01), and continuity equation (39%, P = .017) but not in comparison to 3D planimetry (62%, P = .165).
CONCLUSIONS: Novel measures of the stenotic MV 3DOA in patients with rheumatic heart disease are significantly smaller than calculated values obtained by conventional methods and may be consistent with a higher incidence of severe MS compared to 2D techniques. Further investigation is warranted to determine the clinical relevance of 3D echocardiographic techniques used to measure MV area
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