- 期刊
Evaluation of Valvular Changes by Three- Dimensional Echocardiography in Patients with Mitral Stenosis Undergoing Percutaneous Transvenous Mitral Commissurotomy: A Preliminary Study
三維心臟超音波對接受經皮穿靜脈二尖瓣成型術之二尖瓣狹窄病患其瓣膜變化之評估：一初步研究
摘要
雖然對接受經皮穿靜脈二尖瓣成型術之瓣膜狹窄病患之評估主賴二維杜←勒超音波及血流動力學之方法，但近來之研究顯示三維心臟超音波是一有潛力之診斷工具。在本研究中，經出對接受經皮穿靜脈二尖瓣成型術病人之檢查，對三維心臟超音波之臨床運用予以評估。在10個接受經皮穿靜脈二尖瓣成型術之病人，我們以四種方法（二維心臟超音波，杜卜勒壓力減半時間，血流動力學及三維心臟超音波）評估一三尖瓣出口面積。由二維與三維心臟超音波測量出之二尖瓣出口面積分別與杜←勒壓力減半時間及血流動力學方法測出之面積作比較，瓣膜形態學之變化亦經由三維影像重組後予以評估。在接受經皮穿靜脈三尖瓣成型術前後，三維心臟超音波與杜卜勒壓力減半時間之方法測量三尖瓣出口面積具有最佳之相關性（r=0.87，p=0. 0 01及r=0.94，p=0.0001）。經皮穿靜脈二尖瓣成型術前後瓣膜形態學之變化，先前並無法由二維心臟超音波作良好之評估，經由三維心臟超音波可以在一些病人得到良好之影像。故在經皮穿靜脈二尖瓣成型術前後，評估二尖瓣出口面積及瓣膜形態學變化，三維心臟超音波應可成為一有潛力之評估方法，它在介入性處理三尖瓣狹窄前後，對三尖瓣出口面積之測量具備了與杜卜勒方法最佳之相關性，且在部份病人，亦確實呈現了瓣膜及瓣膜下之變化。
並列摘要
Although evaluation of patients with mitral stenosis for percutaneous transvenous mitral commissurotomy (PTMC) has relied on two-dimensional Doppler echocardiographic and hemodynamic methods, recent studies have highlighted on the potential role of threedimensional echocardiography (3-DE) as a diagnostic tool. In this study, clinical utility of 3-DE was evaluated in patients before and after PTMC. The mitral valve area (MVA) was assessed by 4 methods (two-dimensional echocardiography, Doppler pressure half-time, invasive hemodynamic method and 3-DE) in 10 patients before and after the PTMC. The valve areas assessed by 3-DE and two-dimensional echocardiography (2-DE) were compared with those derived from Doppler pressure half-time method and cardiac catheterization method, respectively. Morphologic changes of the mitral valve were also examined with the use of threedimensional image reconstruction. The 3-DE method had the best fit with Doppler pressure halftime method in assessing MVA before and after PTMC (r=0.87, p=0.001 and r=0.94, p=0.0001, respectively). Good assessment of morphologic changes, including valvular and subvalvular changes, which cannot be well assessed by 2-DE, before and after PTMC was also achieved in some cases by means of three-dimensional image reconstruction. The 3-DE method is suggested to be a potentially useful method for assessing MVA and morphology change before and after PTMC. It affords the best correlation with pressure half-time method in determing MVA before and after intervention. In some cases, it also reliably demonstrates valvular and subvalvular changes after sucessful PTMC.
延伸閱讀
- Hsieh, K. S., Lin, C. C., Liu, W. S., & Chen, F. L. (1996). 二維超音波之動態三度空間影像重組於常見先天性心臓病之應用. Acta Paediatrica Sinica, 37(1), 27-30. https://doi.org/10.7097/APS.199602.0027
- Su, C. H., Weng, K. P., Chang, J. K., Lin, C. C., Hwang, Y. T., Lee, C. L., Chien, K. Y., Chen, F. L., Yu, C. K., Liu, W. S., & Ta (2005). 心房中隔缺損：即時三度立體空間彩色杜卜勒超音波在介入性心導管的處置評估. Acta Cardiologica Sinica, 21(3), 146-152. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200509-21-3-146-152-a
- 陳豐霖（2007）。即時三維心臟超音波應用於先天性中隔缺損治療的重要性：評估心房中隔缺損心室中隔缺損及引導治療步驟〔博士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU.2007.00009
- 廖仲斌（2007）。即時三度立體心臟超音波應用於心房中隔缺損測量之研究〔碩士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU.2007.00123
- 蘇文鉁、馬芳傑（1984）。利用僧帽瓣及主動脈瓣超音波心圖來推測心輸出量及心室中隔缺損其分流之大小。Acta Paediatrica Sinica，25(4)，377-380。https://www.airitilibrary.com/Article/Detail?DocID=00016578-198412-25-4-377-380-a