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目的评价实时三维经胸超声心动图在诊断二尖瓣脱垂中的临床应用价值。方法 34例二尖瓣脱垂伴中度以上反流患者,术前行实时三维经胸超声心动图检查,判断并记录二尖瓣瓣膜病变类型和小叶分区定位,并与外科手术对照。实时三维超声心动图和外科手术中二尖瓣的解剖定位均采用Carpentier命名法,将前叶分为A1、A2和A3,后叶分为P1、P2和P3。所有患者在行实时三维经胸超声心动图1周内行外科手术,由外科医师记录二尖瓣脱垂、腱索断裂等病理类型及二尖瓣小叶具体的病变部位。结果实时三维经胸超声心动图能清晰地显示二尖瓣的前叶和后叶的形态和空间结构,并能分别从左房面和左室面观测二尖瓣及其腱索。与外科手术相对照,实时三维经胸超声心动图定性诊断二尖瓣脱垂的准确率为100%,诊断二尖瓣脱垂病理改变的准确率为94.1%(32/34),定位诊断二尖瓣前、后叶病变区域的准确率为91.2%(31/34)。结论实时三维经胸超声心动图能清晰显示脱垂二尖瓣的病理形态,并对二尖瓣瓣叶进行准确分区和定位病变区域,在诊断二尖瓣脱垂中具有重要的临床价值。
Objective To evaluate the clinical value of real-time three-dimensional transthoracic echocardiography in the diagnosis of mitral valve prolapse. Methods Thirty-four patients with mitral valve prolapse accompanied by moderate or more reflux were examined by real-time three-dimensional transthoracic echocardiography before operation to determine and record the mitral valve lesion type and the subdivision of mitral valve. Real-time three-dimensional echocardiography and surgical anatomy of the mitral valve are used Carpentier nomenclature, the anterior leaf is divided into A1, A2 and A3, the posterior lobe is divided into P1, P2 and P3. All patients underwent real-time three-dimensional transthoracic echocardiography underwent surgery within one week. Surgeons recorded mitral valve prolapse and chordal rupture and other pathological types and mitral valve leaflets specific lesion. Results Real-time three-dimensional transthoracic echocardiography clearly showed the morphology and spatial structure of anterior and posterior lobes of the mitral valve. The mitral valve and its chordae could be observed from left atrium and left ventricular surface respectively. Compared with the surgical operation, the accuracy of real-time three-dimensional transthoracic echocardiography in the diagnosis of mitral valve prolapse was 100%, the accuracy of diagnosis of mitral valve prolapse pathological changes was 94.1% (32/34) The accuracy of anterior and posterior leaflet lesions was 91.2% (31/34). Conclusion The real-time three-dimensional transthoracic echocardiography can clearly show the pathological morphology of the prolapsed mitral valve and the accurate segmentation and localization of the mitral valve leaflets. It has important clinical value in the diagnosis of mitral valve prolapse.