經(jīng)食管實(shí)時(shí)三維超聲心動(dòng)圖定量分析獲得性病變二尖瓣的結(jié)構(gòu)
發(fā)布時(shí)間：2018-09-11 07:00
【摘要】：目的應(yīng)用經(jīng)食管實(shí)時(shí)三維超聲心動(dòng)圖及量化分析軟件分析風(fēng)濕心臟病、退行性變及慢性繼發(fā)性二尖瓣病變致二尖瓣環(huán)及瓣葉結(jié)構(gòu)的變化特點(diǎn)。方法本研究共分兩部分,分別比較原發(fā)性二尖瓣病變與正常對(duì)照組,慢性繼發(fā)性二尖瓣病變與正常對(duì)照組。風(fēng)濕組21例(二尖瓣重度狹窄9例,二尖瓣重度關(guān)閉不全6例,二尖瓣重度狹窄伴重度關(guān)閉不全6例)、退行性變19例(均為二尖瓣脫垂伴大量返流)、繼發(fā)于主動(dòng)脈關(guān)閉不全致二尖瓣重度返流組20例與正常對(duì)照組20例均行經(jīng)食管實(shí)時(shí)三維超聲心動(dòng)圖檢查,并使用Tom Tec-Arena?1.0-4D MV-Assessment?2.3量化分析軟件進(jìn)行后處理分析。結(jié)果第一部分:風(fēng)濕性二尖瓣病變對(duì)二尖瓣瓣環(huán)的影響體現(xiàn)在瓣環(huán)前后徑增大,橫徑變化不大;退行性二尖瓣病變致瓣環(huán)前后徑、瓣環(huán)橫徑均擴(kuò)張明顯,瓣環(huán)的球形指數(shù)(Sphericity index)反而沒(méi)有增大,而瓣環(huán)的周長(zhǎng)、面積均增大,瓣環(huán)原有的“馬鞍形”立體結(jié)構(gòu)趨于平坦。對(duì)瓣葉的影響,風(fēng)濕性病變主要影響二尖瓣前葉,有狹窄病變時(shí)前葉面積、長(zhǎng)度較正常組明顯增大,后葉面積改變則不顯著;退行性變使二尖瓣前、后瓣葉面積均顯著增大;后葉與瓣環(huán)夾角以風(fēng)濕性二尖瓣狹窄伴關(guān)閉不全組增大顯著。無(wú)論是風(fēng)濕各組還是退行性病變組,二尖瓣前后徑與主動(dòng)脈瓣環(huán)間夾角均顯著增大。對(duì)二尖瓣動(dòng)態(tài)分析中發(fā)現(xiàn),風(fēng)濕組二尖瓣瓣環(huán)的最大位移、瓣環(huán)面積的壓縮比較對(duì)照組明顯減小,而退行性變組則變化不顯著。第二部分:左室舒張末期內(nèi)徑組間差異顯著,慢性繼發(fā)性二尖瓣關(guān)閉不全(Chronic Secondary Mitral Regurgitation,CSMR)組較對(duì)照組明顯增大;與正常組相比較,慢性繼發(fā)性二尖瓣關(guān)閉不全組的瓣環(huán)前后徑、左右纖維三角間徑、瓣環(huán)周長(zhǎng)、瓣環(huán)面積均增大,瓣環(huán)球形指數(shù)及前后瓣環(huán)間角度無(wú)統(tǒng)計(jì)學(xué)差異。慢性繼發(fā)性二尖瓣關(guān)閉不全組瓣環(huán)高度較正常組小。AHCWR即瓣環(huán)高度(Annular Height)與跨前后交界間徑(Commissural Width)的比值,通常認(rèn)為其值減低提示二尖瓣環(huán)變平。CSMR組AHCWR值較正常組減小。對(duì)瓣葉的分析,前葉面積及前葉瓣環(huán)至閉合緣的長(zhǎng)度較對(duì)照組均無(wú)統(tǒng)計(jì)學(xué)差異,而后葉面積及后葉瓣環(huán)至閉合緣的長(zhǎng)度較對(duì)照組增大。兩組間后葉與瓣環(huán)夾角、二尖瓣前葉對(duì)合緣長(zhǎng)度、二尖瓣后葉對(duì)合緣長(zhǎng)度均無(wú)明顯差異。CSMR組二尖瓣前后徑與主動(dòng)脈瓣環(huán)間夾角較對(duì)照組增大。對(duì)瓣環(huán)的動(dòng)態(tài)分析發(fā)現(xiàn),CSMR組二尖瓣環(huán)最大位移、瓣環(huán)面積的壓縮比均較對(duì)照組減小。結(jié)論1.風(fēng)濕性二尖瓣病變主要侵害瓣葉及瓣下結(jié)構(gòu),對(duì)瓣環(huán)的影響相對(duì)較小,但瓣葉的病變明顯限制了瓣環(huán)的運(yùn)動(dòng);2.退行性病變時(shí)瓣環(huán)明顯擴(kuò)張、扁平,但仍保留“馬鞍形結(jié)構(gòu);3.主動(dòng)脈瓣關(guān)閉不全繼發(fā)性二尖瓣關(guān)閉不全時(shí),伴隨左心室的增大二尖瓣環(huán)擴(kuò)張、變平,二尖瓣瓣葉閉合障礙。
[Abstract]:Objective to analyze the characteristics of mitral annulus and lobes in patients with rheumatic heart disease, degenerative disease and chronic secondary mitral valve disease by transesophageal real-time three-dimensional echocardiography and quantitative analysis software. Methods the study was divided into two parts: primary mitral valve disease and normal control group, chronic secondary mitral valve disease and normal control group. In rheumatic group, 21 cases (9 cases of severe mitral stenosis, 6 cases of severe mitral insufficiency), There were 6 cases of severe mitral stenosis with severe regurgitation), 19 cases of degenerative mitral valve prolapse with massive regurgitation, 20 cases of severe mitral regurgitation caused by aortic insufficiency and 20 cases of normal control group. Tube real-time three-dimensional echocardiography, And use Tom Tec-Arena?1.0-4D MV-Assessment?2.3 quantitative analysis software for post-processing analysis. Results in the first part, the effect of rheumatic mitral valve disease on mitral annulus was reflected in the enlargement of the anterior and posterior diameter of mitral annulus, the little change in the transverse diameter of mitral annulus, and the obvious dilatation of the anterior and posterior diameter of the annular and the transverse diameter of the annulus caused by degenerative mitral valve disease. However, the spherical index (Sphericity index) of the annulus does not increase, but the circumference and area of the annulus increase, and the original "saddle shape" structure of the annulus tends to be flat. The anterior lobe area of mitral valve was mainly affected by rheumatic lesion, the length of anterior lobe was significantly larger than that of normal group, but the change of posterior lobe area was not significant, degenerative mitral valve and posterior lobe area were significantly increased. The angle between posterior lobe and annulus was significantly increased in rheumatic mitral stenosis with insufficiency. In both rheumatic and degenerative groups, the anterior and posterior diameter of mitral valve and the angle between aortic annulus were significantly increased. In the dynamic analysis of mitral valve, it was found that the maximum displacement of mitral annulus and the compression of annular area in rheumatic group were significantly smaller than those in control group, but there was no significant change in degenerative group. Part two: the difference of left ventricular end-diastolic diameter between groups was significant, and that of chronic secondary mitral insufficiency (Chronic Secondary Mitral Regurgitation,CSMR) group was significantly larger than that of control group, and the anterior and posterior annular diameter of chronic secondary mitral insufficiency group was significantly higher than that of normal group. The diameter of the left and right fibers, the circumference of the annulus and the area of the annulus increased, but there was no significant difference in the global index of the valve and the angle between the anterior and posterior annulus. The value of AHCWR in the patients with chronic mitral insufficiency was smaller than that in the normal group. The ratio of annular height (Annular Height) to the cross anterior and posterior interfacial diameter (Commissural Width) was generally considered as indicating that the AHCWR value in the mitral annular flattening group was lower than that in the normal group. There was no significant difference in the area of the anterior lobe and the length from the annulus to the closing edge of the anterior lobe compared with the control group, but the area of the posterior lobe and the length of the annulus from the posterior lobe to the closing edge of the control group were larger than that of the control group. There was no significant difference in the angle between posterior lobe and annulus, the length of anterior mitral valve involute edge and the length of posterior mitral valve involute edge. The anterior and posterior diameter of mitral valve and the angle between aortic annulus in CSMR group were larger than those in control group. The results of dynamic analysis of mitral annulus showed that the maximum displacement of mitral annulus and the compression ratio of annular area in CSMR group were lower than those in control group. Conclusion 1. Rheumatic mitral valve lesion mainly invades the lobes and subvalvular structures, and has relatively little effect on the annulus, but the lesion of the valvular lobe obviously limits the movement of the annulus. In degenerative lesions, the annulus is obviously dilated and flat, but the saddle structure remains. Aortic insufficiency secondary mitral insufficiency accompanied by left ventricular enlargement mitral annulus dilatation flattening mitral valve lobe closure disorder.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2
本文編號(hào)：2235951
[Abstract]:Objective to analyze the characteristics of mitral annulus and lobes in patients with rheumatic heart disease, degenerative disease and chronic secondary mitral valve disease by transesophageal real-time three-dimensional echocardiography and quantitative analysis software. Methods the study was divided into two parts: primary mitral valve disease and normal control group, chronic secondary mitral valve disease and normal control group. In rheumatic group, 21 cases (9 cases of severe mitral stenosis, 6 cases of severe mitral insufficiency), There were 6 cases of severe mitral stenosis with severe regurgitation), 19 cases of degenerative mitral valve prolapse with massive regurgitation, 20 cases of severe mitral regurgitation caused by aortic insufficiency and 20 cases of normal control group. Tube real-time three-dimensional echocardiography, And use Tom Tec-Arena?1.0-4D MV-Assessment?2.3 quantitative analysis software for post-processing analysis. Results in the first part, the effect of rheumatic mitral valve disease on mitral annulus was reflected in the enlargement of the anterior and posterior diameter of mitral annulus, the little change in the transverse diameter of mitral annulus, and the obvious dilatation of the anterior and posterior diameter of the annular and the transverse diameter of the annulus caused by degenerative mitral valve disease. However, the spherical index (Sphericity index) of the annulus does not increase, but the circumference and area of the annulus increase, and the original "saddle shape" structure of the annulus tends to be flat. The anterior lobe area of mitral valve was mainly affected by rheumatic lesion, the length of anterior lobe was significantly larger than that of normal group, but the change of posterior lobe area was not significant, degenerative mitral valve and posterior lobe area were significantly increased. The angle between posterior lobe and annulus was significantly increased in rheumatic mitral stenosis with insufficiency. In both rheumatic and degenerative groups, the anterior and posterior diameter of mitral valve and the angle between aortic annulus were significantly increased. In the dynamic analysis of mitral valve, it was found that the maximum displacement of mitral annulus and the compression of annular area in rheumatic group were significantly smaller than those in control group, but there was no significant change in degenerative group. Part two: the difference of left ventricular end-diastolic diameter between groups was significant, and that of chronic secondary mitral insufficiency (Chronic Secondary Mitral Regurgitation,CSMR) group was significantly larger than that of control group, and the anterior and posterior annular diameter of chronic secondary mitral insufficiency group was significantly higher than that of normal group. The diameter of the left and right fibers, the circumference of the annulus and the area of the annulus increased, but there was no significant difference in the global index of the valve and the angle between the anterior and posterior annulus. The value of AHCWR in the patients with chronic mitral insufficiency was smaller than that in the normal group. The ratio of annular height (Annular Height) to the cross anterior and posterior interfacial diameter (Commissural Width) was generally considered as indicating that the AHCWR value in the mitral annular flattening group was lower than that in the normal group. There was no significant difference in the area of the anterior lobe and the length from the annulus to the closing edge of the anterior lobe compared with the control group, but the area of the posterior lobe and the length of the annulus from the posterior lobe to the closing edge of the control group were larger than that of the control group. There was no significant difference in the angle between posterior lobe and annulus, the length of anterior mitral valve involute edge and the length of posterior mitral valve involute edge. The anterior and posterior diameter of mitral valve and the angle between aortic annulus in CSMR group were larger than those in control group. The results of dynamic analysis of mitral annulus showed that the maximum displacement of mitral annulus and the compression ratio of annular area in CSMR group were lower than those in control group. Conclusion 1. Rheumatic mitral valve lesion mainly invades the lobes and subvalvular structures, and has relatively little effect on the annulus, but the lesion of the valvular lobe obviously limits the movement of the annulus. In degenerative lesions, the annulus is obviously dilated and flat, but the saddle structure remains. Aortic insufficiency secondary mitral insufficiency accompanied by left ventricular enlargement mitral annulus dilatation flattening mitral valve lobe closure disorder.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2
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