Objective To analyze abnormal characteristics of mitral valve (MV) caused by rheumatic and degenerative mitral valvedisease in virtue of the real-time three-dimensional transesophageal echocardiography(RT3DTEE) and quantitative analysis software.Methods Sixty patients underwent RT3DTEE study:21 patients with rheumatic valvular disease(RHD) studied intraoperatively(9 severe mitral stenosis,6 severe mitral regurgitation,6 severe mitral stenosis couple with regurgitation ) and 20 patients with normal MV who were used as controlsubjects(NS).TomTec-Arena 1.0-4D MV-Assessment 2.3 software was used to measure parameters of annular dimensions and geometry,[eafletsurface area and so on.Results Compared with NS,the diameter between anterior and posterior(AP) of RIID increased,however,the commissural width (CW)didn't change.Parameters of AP,CW,annulus circumference(AC) and annulus area(AA) of degenerative mitral valve disease(DMVD) increased obviously,the spherical index instead didn't change,the original "saddle" shapebecame flat.The impact on mitral valve leaflets is difference between RHD and DMVD.The anterior instead of posterior leaflet arena and length became larger of the group MS and MS&MI.However,the group of DMVD has increased leaflet area of anterior as well as posterior.Posterior leaflet angle is significantly increased in the group of MS&MI.The angle,between the DAP and plane of aortic valve annular (Angle AAo-AP),were magnified in both RHD and DMVD.From the automatic dynamic analysis,the parameters of annular displacement(max),annulus area fraction(2D)decreased considerably in RHD group.Conclusion RHD has relatively mild impact on annular of MV,but the lesions of mitral valve leaflet and chordae tendineae limit the movement of bicuspid valve an nular.The dilated and flattened annular of DMVD still has the "saddle" shape.%目的 应用经食管实时三维超声心动图及量化分析软件分析风湿性瓣膜病及退行性病变致二尖瓣环及瓣叶结构的变化特点.方法 风湿组21例(重度狭窄9例,重度关闭不全6例,重度狭窄伴重度关闭不全6例)、退行性变19例(均为二尖瓣脱垂伴大量反流)与正常对照组20例均行经食管实时三维超声心动图检查,并使用TomTec-Arena 1.0-4D MV-Assessment 2.3量化分析软件进行后处理分析.结果 风湿性二尖瓣病变对二尖瓣瓣环的影响体现在瓣环前后径增大,横径变化不大;退行性二尖瓣病变致瓣环前后径、瓣环横径均扩张明显,瓣环的球形指数(sphericity index)未增大,而瓣环的周长、面积均增大,瓣环原有的“马鞍形”立体结构趋于平坦.对瓣叶的影响,风湿性病变主要影响二尖瓣前叶,有狭窄病变时前叶面积、长度较正常组明显增大,后叶面积改变则不显著;退行性变使二尖瓣前、后瓣叶面积均显著增大;后叶与瓣环夹角以风湿性二尖瓣狭窄伴关闭不全组增大显著.无论是风湿各组还是退行性病变组,二尖瓣前后径与主动脉瓣环间夹角均显著增大.对二尖瓣动态分析中发现,风湿组二尖瓣瓣环的最大位移、瓣环面积的压缩比较对照组明显减小,而退行性变组则变化不显著.结论 风湿性病变主要侵害二尖瓣瓣叶及瓣下结构,对瓣环的影响相对较小,但瓣叶的病变明显限制了瓣环的运动.退行性病变时二尖瓣瓣环明显扩张、扁平,但仍保留“马鞍形”结构.
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