Diagnostic approach and accuracy of echocardiography in congenital mitral insufficiency
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摘要: 目的 分析先天性二尖瓣关闭不全(CMI)超声心动图影像特征，以外科手术探查结果为金标准，探讨超声心动图对CMI的诊断方法及诊断准确性。方法 回顾性分析2016年10月—2022年4月于阜外医院行超声心动图检查诊断为中度及以上的儿童CMI患者，均行二维及三维超声心动图对二尖瓣关闭不全的病理结构、反流程度进行了定性及定量诊断。以外科手术探查结果为金标准，探讨超声心动图诊断CMI的准确性，总结超声心动图对于CMI的诊断方法和评估要点。结果 研究共纳入130例儿童CMI患者，超声诊断二尖瓣病理结构包括二尖瓣腱索分化不良82例(63.1%)，功能性二尖瓣反流21例(16.2%)，缺血性二尖瓣反流14例(10.8%)，二尖瓣脱垂9例(6.9%)，二尖瓣瓣叶裂4例(3.1%)。以手术探查结果为金标准，超声心动图总诊断准确率94.6%。2例二尖瓣脱垂误诊为腱索分化不良，5例功能性反流漏诊了腱索异常连接。结论 超声心动图检查是儿童CMI的精准诊断工具，能够有效指导外科治疗策略。
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关键词:
- 先天性二尖瓣关闭不全 /
- 超声心动图 /
- 腱索分化不良 /
- 缺血 /
- 脱垂
Abstract: Objective To analyze the echocardiographic features of congenital mitral insufficiency(CMI). The surgical exploration results were used as the gold standard, and then the diagnostic accuracy of echocardiography for CMI was discussed.Methods Children with moderate and more than moderate CMI diagnosed by echocardiography in Fuwai Hospital from October 2016 to April 2022 were analysed retrospectively. The pathological structure and severity of mitral regurgitation(MR) were evaluated qualitatively and quantitatively by two-dimensional and three-dimensional echocardiography. With reference to the surgical exploration results as the gold standard, the accuracy of echocardiography in the diagnosis of CMI was discussed, and the diagnostic methods and evaluation points of echocardiography for CMI were summarized.Results A total of 130 children with CMI were included in the study. Echocardiography showed that the mitral valve pathology consisted of undifferentiated chordae tendineae of mitral valve in 82 cases(63.1%), functional MR in 21 cases(16.2%), ischemic MR in 14 cases(10.8%), mitral valve prolapse in 9 cases(6.9%) and isolated cleft in 4 cases(3.1%). Echocardiography was found to be 94.6% accurate compared with surgical exploration results. Two cases of mitral valve prolapse were misdiagnosed as undifferentiated chordae tendineae, and 5 cases of functional regurgitation missed the diagnosis of abnormal connection of chordae tendineae.Conclusion Echocardiography is an accurate diagnostic tool for CMI in children and can be used to guide surgical treatment strategies. -
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表 1 130例患儿二尖瓣反流严重程度及合并畸形情况
Table 1. The mitral regurgitation severity and associated anomaly in 130 children
例(%) 指标 二尖瓣腱索分化不良(82例) 功能性二尖瓣反流(21例) 缺血性二尖瓣反流(14例) 二尖瓣脱垂(9例) 二尖瓣瓣叶裂(4例) 反流程度 中度 12(14.6) 8(38.1) 0(0) 0(0) 0(0) 中重度 13(15.9) 8(38.1) 4(28.6) 4(44.4) 0(0) 重度 57(69.5) 5(23.8) 10(71.4) 5(55.6) 4(100.0) 合并其他畸形 简单畸形 46(56.1) 11(52.4) 0(0) 3(33.3) 1(25.0) 复杂畸形 4(4.9) 9(42.9) 14(100.0) 1(11.1) 0(0) 
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[1] Meier S, Seeburger J, Borger MA. Advances in Mitral Valve Surgery[J]. Curr Treat Options Cardiovasc Med, 2018, 20(9): 75. doi: 10.1007/s11936-018-0666-3
[2] Baghaei R, Tabib A, Jalili F, et al. Early and Mid-Term Outcome of Pediatric Congenital Mitral Valve Surgery[J]. Res Cardiovasc Med, 2015, 4(3): e28724.
[3] Stellin G, Padalino M, Milanesi O, et al. Repair of congenital mitral valve dysplasia in infants and children: is it always possible?[J]. Eur J Cardiothorac Surg, 2000, 18(1): 74-82. doi: 10.1016/S1010-7940(00)00457-7
[4] Pang K, Wang J, Zhang T, et al. Undifferentiated Chordae Tendineae of the Mitral Valve: Large Cohort Study of a Rare Mitral Malformation[J]. Front Cardiovasc Med, 2021, 8: 695536. doi: 10.3389/fcvm.2021.695536
[5] Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging[J]. Eur Heart J Cardiovasc Imaging, 2013, 14(7): 611-644. doi: 10.1093/ehjci/jet105
[6] Cherry SV, Jain P, Rodriguez-Blanco YF, et al. Noninvasive Evaluation of Native Valvular Regurgitation: A Review of the 2017 American Society of Echocardiography Guidelines for the Perioperative Echocardiographer[J]. J Cardiothorac Vasc Anesth, 2018, 32(2): 811-822. doi: 10.1053/j.jvca.2017.10.030
[7] Layman TE, Edwards JE. Anomalous mitral arcade. A type of congenital mitral insufficiency[J]. Circulation, 1967, 35(2): 389-395. doi: 10.1161/01.CIR.35.2.389
[8] Deo SV, Maalouf JF, Mankad SV, et al. Mitral hemi-arcade: an unusual modification of a rare anomaly[J]. J Card Surg, 2012, 27(6): 699-701. doi: 10.1111/j.1540-8191.2012.01524.x
[9] Aramendi JI, Hamzeh G, Crespo A, et al. Partial Hammock Valve: Surgical Repair and Long-Term Follow-Up in 23 Patients[J]. Ann Thorac Surg, 2018, 106(6): 1854-1859. doi: 10.1016/j.athoracsur.2018.05.064
[10] Jin CN, Salgo IS, Schneider RJ, et al. Automated quantification of mitral valve anatomy using anatomical intelligence in three-dimensional echocardiography[J]. Int J Cardiol, 2015, 199: 232-238. doi: 10.1016/j.ijcard.2015.07.018
[11] Ashikhmina E, Shook D, Cobey F, et al. Three-dimensional versus two-dimensional echocardiographic assessment of functional mitral regurgitation proximal isovelocity surface area[J]. Anesth Analg, 2015, 120(3): 534-542. doi: 10.1213/ANE.0000000000000409
[12] Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry[J]. Circulation, 1997, 96(6): 1999-2008. doi: 10.1161/01.CIR.96.6.1999
[13] 宋光远, 刘然, 卢志南, 等. 功能性二尖瓣反流的治疗策略[J]. 临床心血管病杂志, 2022, 38(6): 433-438. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.06.002
[14] 洪雯静, 吴兰平, 张玉奇, 等. 不同年龄儿童左冠状动脉异常起源于肺动脉的超声心动图比较[J]. 医学影像学杂志, 2016, 26(3): 413-417. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201603013.htm
[15] Cohen MS, Herlong RJ, Silverman NH. Echocardiographic imaging of anomalous origin of the coronary arteries[J]. Cardiol Young, 2010, 20 Suppl 3: 26-34.
[16] Volpato V, Mantegazza V, Tamborini G, et al. Diagnostic Accuracy of Transillumination in Mitral Valve Prolapse: Side-by-Sid Comparison of Standard Transthoracic Three-Dimensional Echocardiography against Surgical Findings[J]. J Am Soc Echocardiogr, 2021, 34(1): 98-100. doi: 10.1016/j.echo.2020.08.017
[17] Abadir S, Fouilloux V, Metras D, et al. Isolated cleft of the mitral valve: distinctive features and surgical management[J]. Ann Thorac Surg, 2009, 88(3): 839-843. doi: 10.1016/j.athoracsur.2009.06.004
[18] Fraisse A, Massih TA, Kreitmann B, et al. Characteristics and management of cleft mitral valve[J]. J Am Coll Cardiol, 2003, 42(11): 1988-1993. doi: 10.1016/j.jacc.2003.07.019
[19] 董念国, 曹红, 周廷文, 等. 心脏瓣膜病治疗进展[J]. 临床心血管病杂志, 2022, 38(6): 429-432. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.06.001
[20] 莫绪明, 李守军, 彭卫, 等. 先天性心脏病外科治疗中国专家共识(十三): 先天性二尖瓣畸形[J]. 中国胸心血管外科临床杂志, 2020, 27(12): 1382-1388. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX202012003.htm
[21] Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment[J]. J Thorac Cardiovasc Surg, 1976, 72(6): 854-866. doi: 10.1016/S0022-5223(19)40003-2
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