目的 观察术中三维超声技术检测二尖瓣成形术前后二尖瓣环空间构型的变化.方法 选择单纯二尖瓣退行性变导致重度瓣膜反流患者36例,无其他合并心脏疾病.入院后体表二维超声检测,在手术室术前经食管三维超声检测复查二尖瓣反流部位和程度,以及二尖瓣瓣环空间构型,包括二尖瓣环环径、横径、纵径、瓣环高度、前叶合后叶非平面夹角等,并初步确立手术成形方法.术后同样进行三维食管超声检测相同内容.结果 36例患者术前体表二维超声检查与术中发现完全吻合者26例(72.2％),部分吻合6例(16.7％),差距较大4例(1 1.1％).在整个心动周期中二尖瓣环持续呈“马鞍形”,于前外侧交界、后内侧交界处较低,于前瓣环、后瓣环较高.手术前后瓣环周长、瓣环横径和瓣环纵径分别为(12.4±1.4)、(7.5±0.5)cm;(34.8±2.7)、(21.8 ±1.8)mm;(34.9±3.1)、(20.4±2.1)mm.手术前后瓣环周长、瓣环横径和瓣环纵径差异均有统计学意义(均P ＜0.05).在收缩期,前瓣环与后瓣环之间夹角较大,在舒张期,前叶侧瓣环与后叶侧瓣环之间夹角较小.二尖瓣成形术后二尖瓣瓣环周长、横径、纵径较术前有减少.术前二尖瓣横径和纵径测量值几乎相同,在术后则纵径/横径达到93％.瓣环高度由术前(8.4±0.6) mm降低到术后的(3.0±0.1)mm,瓣环高度/横径比值由术前24％降低到14％.前后瓣环非平面夹角在成形术后由(135±14)°增加为(145±13)°,与术前比较,差异均有统计学意义(均P＜0.05).结论 二尖瓣成形术后瓣环空间构型会由于人工瓣环的使用而发生变化.%Objective To investigate the configuration changes after mitral repair by three dimensional echocardiography in the operation room.Methods Serious mitral prolapse without other cardiac disorders were chosen.The routine two dimensional echocardiography was performed after admission.3 dimensional echocardiography was performed before the operation in the operation room.The mitral annulus configuration,the mitral prolapse and regurgitation grades were examined.The mitral annulus diameter,the distance between commisure1 and commisure2,distance between anterior and posterior annulus,the annulus height and the non-planer angel were measured.The primary repair strategies were evaluated.The same procedure was done after the surgery.Results Totally 36 cases were enrolled,fully consistent with the intraoperative findings had 26 cases (72.2％),partially coincide had 6 cases (16.7％),the gap was larger in 4 cases (11.1％).The mitral annulus appears consistently as saddle shape during the whole movement phase,the lowest height was at the commissure part and the highest part was at the annulus.During the systolic phase the non-planer angel between anterior and posterior annuls appeared bigger than in diastolic phase.Disc ring circumference the disc ring diameter and disc ring longitudinal diameter before and after operation was (12.4 ± 2.4) cm,(7.5 ± 0.5) cm; (34.8 ± 2.7) mm,(21.8 ± 1.8) mm; (34.9 ± 3.1) mm,(20.4 ± 2.1) mm,respectively.The difference of disc ring circumference the disc ring diameter and disc ring longitudinal diameter before and after operation were statistically significant (P ＜ 0.05).The annulus circumference,transverse,longitudinal diameters decreased compared with before the surgery.Preoperative mitral transverse diameter and longitudinal diameter values are almost the same,indicating that at this time the mitral annulus was in nearly round shape.However the longitudinal/transverse ratio reached 93％ after surgery also implied that the mitral annulus configuration recovery after annuloplasty.After the surgery the annulus height decreased from (8.4 ± 0.6) mm to (3.0 ± 0.1) mm while the annular height/transverse diameter ratio decreased from 24％ to 14％.Non-planar angle between the anterior and posterior mitral annuls increased from (135 ± 14) degrees to (145 ± 13) degrees after surgery(P ＜ 0.05).Conclusion The mitral annulus configuration may change after artificial annulus applied in the repair surgery.
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