超声心动图评估二尖瓣狭窄开口面积：新的三维方法与传统方法的比较
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Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Technique
背景与目的
临床上通常使用二维（2D）超声心动图技术评价二尖瓣狭窄（MS）的严重程度。然而，的二尖瓣（MV）复杂的三维（3D）结构对之前用测量其孔径面积的二维成像方式的准确性提出了质疑。我们的目的是通过比较传统超声方法对三维成像测量孔径面积的方法（3DOA）（即一种新的超声技术，可以最大限度地减少几何假设）。来测量的MV的面积，从而评估MS严重程度。
方 法
回顾性分析26例至少有中度及以上风湿性心脏病成人手术患者的常规二维和三维经食管超声心动图图像。测量半时压力（PTH）可得到二尖瓣瓣口面积，近端等速表面积（PISA）、连续性方程和获得3DOA三维平面的图像进行比较。
结 果
通过测量PTH得到MV面积，PISA，连续性方程，3D法面积，以及3DOA法的面积（均值±标准差）分别是：1.12±0.27，1.03±0.27、1.16±0.35、0.97±0.25，和0.76±0.21 cm2。3DOA法方法得到的面积比来自PHT的面积明显减小（平均差0.35cm2，P＜0.0001），PISA（平均差：0.28cm2，P = 0.0002），连续性方程（平均差：0.43cm2，P = 0.0015），和3D法面积（平均差：0.19cm2，P＜0.0001）。 3DOA测量MV面积时还发现有更大比例的患者存在重度MS：（88%），PHT（31%，P = 0.006），PISA（42%，P = 0.01），和连续性方程法（39%，P = 0.017）。除了在与3D法的比较时（62%，P = 0.165）。
结 论
在测量风湿性心脏病患者狭窄的MV面积时，3DOA法比常规方法得到的计算值明显偏小。与2D技术相比3DOA法测得的发病率较高。需要进一步的研究来确定三维超声心动图技术用于测量MV区域的临床相关性。
原始文献摘要
Sergey Karamnov, Nelson Burbano-Vera,et al.Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional TechniquesAnesth Analg. 2017 Sep;125(3):774-780.
BACKGROUND AND OBJECTIVES:
A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizestwo-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:
TheRoutine 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:
A MV areas derived by PHT, PISA, continuity equation, 3D planimetry, and3DOA (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 cm2, respectively. Areas obtained from the 3DOA method were significantly smaller than areas derived from PHT (mean difference 0.35 cm2, P<0.0001), PISA (mean difference:0.28 cm2, P=0.0002), continuity equation (mean difference:0.43 cm2, P0=0.0015), and 3D planimetry (mean difference:0.19cm2,P<0.0001). MV 3DOAs also identified a significantly greater percentage of patients with severe MS (88%) compared to PHT (31%, P=0.006), PISA (42%, P=0.01), and continuity equation (39%, P = 0.017) but not in comparison to 3D planimetry (62%, P =0.165).
CONCLUSION:
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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