【摘要】：目的二尖瓣環(huán)擴(kuò)張和變形是產(chǎn)生二尖瓣反流(MR)的重要機(jī)制之一，本研究通過實(shí)時(shí)三維超聲心動(dòng)圖（RT-3DE）對(duì)二尖瓣及瓣環(huán)構(gòu)型在心動(dòng)周期中的動(dòng)態(tài)變化進(jìn)行定量分析，探討二尖瓣環(huán)結(jié)構(gòu)異常與MR反流程度的關(guān)系。方法運(yùn)用飛利浦IE33彩超儀采集41例MR患者的實(shí)時(shí)三維超聲心動(dòng)圖二尖瓣環(huán)圖像，根據(jù)二尖瓣反流程度分為輕度反流組（18例）與重度反流組（23例）兩組；選取21例二尖瓣無反流的正常人作為對(duì)照組。用德國(guó)TomTec公司4D圖像工作站重建二尖瓣環(huán)三維動(dòng)態(tài)圖像，測(cè)量二尖瓣環(huán)三維前后徑(AP)、三維交界徑(CC)、三維前外后內(nèi)徑(ALPM)、前瓣環(huán)長(zhǎng)度(AAL)、后瓣環(huán)長(zhǎng)度(PAL)、三維瓣環(huán)周長(zhǎng)(AC)、瓣環(huán)球形指數(shù)(SI)、非平面角度(NPA)、瓣環(huán)面積(MAA)等各參數(shù)。并且在近二尖瓣水平，對(duì)左心室心肌進(jìn)行斑點(diǎn)追蹤分析，計(jì)算應(yīng)變（S）與位移（D）。結(jié)果正常對(duì)照組21例的二尖瓣環(huán)三維構(gòu)型均呈馬鞍形態(tài)，并在整個(gè)心動(dòng)周期中始終保持此形態(tài)。輕度反流組的二尖瓣環(huán)三維構(gòu)型也呈馬鞍形態(tài)，且在整個(gè)心動(dòng)周期中保持馬鞍形。重度反流組的二尖瓣環(huán)雖呈馬鞍形態(tài)，但在整個(gè)心動(dòng)周期中，，呈扁平圓形。輕度反流組AP、CC、ALPM、NPA、PAL、AC、MAA均較對(duì)照組增大，差異具有統(tǒng)計(jì)學(xué)上的顯著性意義（P＜0.05)。重度反流組不僅AP、CC、ALPM、NPA、MAA、 PAL、AC、較正常組增大，同時(shí)AAL也較正常組增大，并且AP、ALPM較輕度反流組進(jìn)一步增大（P0.05）,差異具有統(tǒng)計(jì)學(xué)上的顯著性差異（P＜0.05)。結(jié)論本文采用RT-3DE方法探討了病理性MR患者二尖瓣環(huán)三維結(jié)構(gòu)與MR產(chǎn)生機(jī)制的關(guān)系，提示病理性MR除了二尖瓣葉病變以外，二尖瓣環(huán)的三維立體形態(tài)可能導(dǎo)致不同程度的MR，具有馬鞍形態(tài)特征的三維二尖瓣環(huán)僅產(chǎn)生輕度反流；偏扁平圓形馬鞍形態(tài)三維二尖瓣環(huán)立體構(gòu)型易導(dǎo)致重度反流。輕度MR多見二尖瓣環(huán)后瓣環(huán)長(zhǎng)度（PAL）增加，重度MR不僅出現(xiàn)PAL增加，而且AAL也增加。
[Abstract]:Objective mitral annulus dilatation and deformity are one of the important mechanisms of mitral regurgitation (MR). In this study, the dynamic changes of mitral valve and annular configuration during cardiac cycle were quantitatively analyzed by real-time three-dimensional echocardiography (RT-3DE). To investigate the relationship between mitral annular anomalies and MR reflux. Methods Real-time three-dimensional echocardiographic mitral annulus images of 41 patients with MR were collected by Philips IE33 color Doppler echocardiography. According to the degree of mitral regurgitation, they were divided into two groups: mild regurgitation group (18 cases) and severe regurgitation group (23 cases). 21 normal persons without mitral regurgitation were selected as control group. Three-dimensional dynamic images of mitral annulus were reconstructed by 4D imaging workstation of TomTec Company in Germany. The length of (ALPM), anterior and posterior annulus (AAL),) was measured by measuring the three-dimensional anteroposterior diameter of mitral annulus (AP),) and the three-dimensional junction diameter (CC),). Length of posterior annulus (PAL), circumference of three dimensional annulus (AC), valve universal index (SI), non-planar angle (NPA), annulus area (MAA) and so on. The strain (S) and displacement (D). Were calculated by dot-tracing analysis of left ventricular myocardium at near mitral valve level. Results the three dimensional configuration of mitral annulus in 21 cases of normal control group showed saddle shape and remained in this shape throughout the cardiac cycle. The three dimensional configuration of mitral annulus in mild regurgitation group was also a saddle shape and remained saddle shape during the whole cardiac cycle. The mitral annulus in severe regurgitation group was in the shape of saddle, but in the whole cardiac cycle, it was flat and round. AP,CC,ALPM,NPA,PAL,AC,MAA in mild reflux group was significantly higher than that in control group (P < 0. 05). The AP,CC,ALPM,NPA,MAA, PAL,AC, of severe reflux group was not only higher than that of normal group, but also the AAL of severe reflux group was larger than that of normal group, and AP,ALPM was further increased compared with mild reflux group (P0.05). The difference was statistically significant (P < 0.05). Conclusion the relationship between the three dimensional structure of mitral annulus and the mechanism of MR production in patients with pathological MR was studied by using RT-3DE method. It is suggested that the three-dimensional morphology of the mitral annulus in pathological MR may lead to different degrees of MR, in addition to the mitral lobe lesion. The three dimensional mitral annulus with saddle shape produced only mild regurgitation. The three-dimensional mitral annulus with a flat circular saddle is prone to severe regurgitation. In mild MR, the length of posterior mitral annulus (PAL) was increased, and severe MR not only increased in PAL, but also increased in AAL.
【學(xué)位授予單位】：內(nèi)蒙古醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R541.1;R363

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