外科矫正二尖瓣膜关闭不全应达到如下目的矫正-第三军医大学学报.doc

实时三维经胸超声心动图在诊断二尖瓣脱垂中的应用价值( 郭燕丽1 王海东2 杨康2 王文婷1 申斌1 郭爱民1（400038 重庆，第三军医大学西南医院：超声科1，心血管外科2） [摘要] 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，为外科手术方式的制定提供可靠的依据，在诊断二尖瓣脱垂中具有重要的临床价值。 [关键词] 超声心动图描记术；实时三维；二尖瓣脱垂；定位 [中图法分类号] 【文献标志码】 A The value of real-time three dimensional transthoracic echocardiography in diagnosing mitral valve prolapse GUO Yan-li1, WANG Hai-dong2, YANG Kang2, WANG Wen-ting1, SHEN Bin1, GUO Ai-ming1 1 Department of Utrasound, 2 Department of Cardial and Thoracic Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, China，40038Abstract] Objective To evaluate the value of real-time three dimensional transthoracic echocardiography in diagnosing mitral valve prolapse. Methods Thirty four patients with mitral valve prolapse with moderate mitral regurgitation were examined by real-time three dimensional transthoracic echocardiography preoperatively.The categories of mitral pathological change and compartmental localization were judged and recorded，and were compared with surgical findings. Carpentier’s nomenclature was applied to the mitral valve anatomic localization of real-time three dimensional echocardiography and surgery. Three anterior leaflet scallops were defined as A1, A2 and A3, and three posterior leaflet scallops were defined as P1, P2 and P3. The surgeons recorded the pathology of mitral valve prolapse, ruptured chordae, and the location of scallop lesions in each eaflet scallop. Results The shape and spatial structure of the anterior and posterior leaflets was clearly displayed using real-time