切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (10) : 932 -936. doi: 10.3877/cma.j.issn.1672-6448.2021.10.006

专题笔谈

功能性二尖瓣反流的超声心动图定量评估
刘金梅1, 牟芸1,()   
  1. 1. 310003 杭州,浙江大学医学院附属第一医院心血管超声中心
  • 收稿日期:2021-06-15 出版日期:2021-10-01
  • 通信作者: 牟芸
  • 基金资助:
    浙江省自然科学基金资助项目(LSD19H180002)

Quantitative echocardiographic assessment of functional mitral regurgitation

Jinmei Liu1, Yun Mou1()   

  • Received:2021-06-15 Published:2021-10-01
  • Corresponding author: Yun Mou
引用本文:

刘金梅, 牟芸. 功能性二尖瓣反流的超声心动图定量评估[J]. 中华医学超声杂志(电子版), 2021, 18(10): 932-936.

Jinmei Liu, Yun Mou. Quantitative echocardiographic assessment of functional mitral regurgitation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(10): 932-936.

表1 二尖瓣关闭不全分型及特征
图1 二维超声心动图测量二尖瓣反流束面积和左心房面积。图a示二尖瓣反流束面积为15.2 cm2;图b示为左心房面积为37.5 cm2
图2 二维超声心动图测量二尖瓣反流颈宽度(VCW)。图a示VCW测量值为0.65 cm;图b示VCW测量值为0.38 cm
图3 二维超声心动图测量二尖瓣反流率、反流量及有效反流口面积。图a为二维超声心动图将底部尼奎斯特极限调至30~40 cm/s,在大致达到连续多普勒血流的峰值时测量近端等速表面积(PISA)半球形的半径r,根据位于瓣口的极限速度v,可计算出反流率为196 ml/s;图b根据二尖瓣反流连续多普勒频谱,测算得出有效反流口面积为0.33 cm2,反流量为45 ml
1
Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study [J]. Lancet, 2006, 368(9540): 1005-1011.
2
d'Arcy JL, Coffey S, Loudon MA, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study [J]. Eur Heart J, 2016, 37(47): 3515-3522.
3
Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome [J]. Eur Heart J, 2019, 40(27): 2194-2202.
4
Benjamin MM, Smith RL, Grayburn PA. Ischemic and functional mitral regurgitation in heart failure: natural history and treatment [J]. Curr Cardiol Rep, 2014, 16(8): 517.
5
吴美华, 陈艰, 尹秋林. 功能性二尖瓣反流研究新进展 [J]. 中华心血管病杂志, 2012, 40(2): 173-175.
6
Tibayan FA, Rodriguez F, Zasio MK, et al. Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation [J]. Circulation, 2003, 108(Suppl 1): Ⅱ116-Ⅱ121.
7
Nouri M, Tokaldany ML, Shahrzad M, et al. Echocardiographic determinants of ischemic mitral regurgitation [J]. J Card Surg, 2013, 28(4): 359-365.
8
Veronesi F, Corsi C, Sugeng L, et al. Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography [J]. J Am Soc Echocardiogr, 2008, 21(4): 347-354.
9
Kihara T, Gillinov AM, Takasaki K, et al. Mitral regurgitation associated with mitral annular dilation in patients with lone atrial fibrillation: an echocardiographic study [J]. Echocardiography, 2009, 26(8): 885-889.
10
Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgitation: JACC review topic of the week [J]. J Am Coll Cardiol, 2019, 73(19): 2465-2476.
11
Sabbagh AE, Reddy YN, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions [J]. JACC Cardiovascular imaging, 2018, 11(4): 628-643.
12
Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance [J]. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
13
潘翠珍, 潘文志, 周达新, 等. 二尖瓣反流介入治疗的超声心动图评价中国专家共识 [J]. 中国介入心脏病学杂志, 2019, 27(1): 43-49.
14
Fehske W, Omran H, Manz M, et al. Color-coded Doppler imaging of the vena contracta as a basis for quantification of pure mitral regurgitation [J]. Am J Cardiol, 1994, 73(4): 268-274.
15
Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease) [J]. Eur J Echocardiogr, 2010, 11(4): 307-332.
16
Grigioni F, Enriquez-Sarano M, Zehr KJ, et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment [J]. Circulation, 2001, 103(13): 1759-1764.
17
Lancellotti P, Troisfontaines P, Toussaint AC, et al. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction [J]. Circulation, 2003, 108(14): 1713-1717.
18
Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) [J]. Eur J Cardiothorac Surg, 2012, 42(4): S1- S44.
19
Kahlert P, Plicht B, Schenk IM, et al. Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography [J]. J Am Soc Echocardiogr, 2008, 21(8): 912-921.
20
Little SH, Pirat B, Kumar R, et al. Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience [J]. JACC Cardiovasc Imaging, 2008, 1(6): 695-704.
21
Matsumura Y, Saracino G, Sugioka K, et al. Determination of regurgitant orifice area with the use of a new three-dimensional flow convergence geometric assumption in functional mitral regurgitation [J]. J Am Soc Echocardiogr, 2008, 21(11): 1251-1256.
22
Lancellotti P, Cosyns B, Zacharakis D, et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking [J]. J Am Soc Echocardiogr, 2008, 21(12): 1331-1336.
23
Zeng X, Levine RA, Hua L, et al. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography [J]. Circ Cardiovasc Imaging, 2011, 4(5): 506-513.
24
Beaudoin J, Handschumacher MD, Zeng X, et al. Mitral valve enlargement in chronic aortic regurgitation as a compensatory mechanism to prevent functional mitral regurgitation in the dilated left ventricle [J]. J Am Coll Cardiol, 2013, 61(17): 1809-1816.
25
Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation [J]. Circulation, 2008, 118(8): 845-852.
26
Little SH, Ben Zekry S, Lawrie GM, et al. Dynamic annular geometry and function in patients with mitral regurgitation: insight from three-dimensional annular tracking [J]. J Am Soc Echocardiogr, 2010, 23(8): 872-879.
27
Silbiger JJ, Bazaz R. Contemporary insights into the functional anatomy of the mitral valve [J]. Am Heart J, 2009, 158(6): 887-895.
28
Watanabe N, Ogasawara Y, Yamaura Y, et al. Mitral annulus flattens in ischemic mitral regurgitation: geometric differences between inferior and anterior myocardial infarction: a real-time 3-dimensional echocardiographic study [J]. Circulation, 2005, 112(9 Suppl): I458-I462.
29
Ryan L, Jackson B, Parish L, et al. Quantification and localization of mitral valve tenting in ischemic mitral regurgitation using real-time three-dimensional echocardiography [J]. Eur J Cardiothorac Surg, 2007, 31(5): 839-844.
30
Tibayan FA, Wilson A, Lai DT, et al. Tenting volume: three-dimensional assessment of geometric perturbations in functional mitral regurgitation and implications for surgical repair [J]. J Heart Valve Dis, 2007, 16(1): 1-7.
31
Hübscher A, Schwerg M, Hoffmann S, et al. Automated quantification of mitral valve tenting volume in functional mitral regurgitation by three-dimensional echocardiography [J]. Echocardiography, 2020, 37(7): 1043-1048.
32
Grayburn PA, Carabello B, Hung J, et al. Defining "severe" secondary mitral regurgitation: emphasizing an integrated approach [J]. J Am Coll Cardiol, 2014, 64(25): 2792-2801.
33
Marwick TH, Zoghbi WA, Narula J. Redrawing the borders: considering guideline revision in functional mitral regurgitation [J]. JACC Cardiovasc Imaging, 2014, 7(3): 333-335.
34
Grayburn PA, Sannino A, Packer M. Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT trials [J]. JACC Cardiovasc Imaging, 2019, 12(2): 353-362.
35
Packer M, Grayburn PA. New evidence supporting a novel conceptual framework for distinguishing proportionate and disproportionate functional mitral regurgitation [J]. JAMA Cardiol, 2020, 5(4): 469-475.
No related articles found!
阅读次数
全文


摘要