超声心动图定量评价二尖瓣偏心反流的方法学研究
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摘要
【目的】探讨多种彩色多普勒超声方法定量评价二尖瓣偏心反流的临床应用价值，以寻求一种准确、方便、实用的测量方法。【方法】选择单纯性二尖瓣偏心反流(Eccentric Mitral Regurgitation，EMR)患者63例和单纯性二尖瓣中心反流(Central Mitral Regurgitation，CMR)患者11例，于左室长轴、心尖四腔、五腔及两腔切面，分别用频谱多普勒法(Continuity Equation Method)、二维彩色多普勒法(CDFI)、血流汇聚法(PISA)、射流紧缩面法(VC)及实时三维彩色多普勒方法(Real-time3D color Doppler)测量二尖瓣的反流程度，结果以连续方程法结果为标准，观察其他方法与之的相关性，进行线性分析，并以中心反流的结果作为对照。【结果】1、在CMR病例组，四种方法与连续方程法结果比较，相关性均不显著(r值均小于0.65，p值均大于0.05)，故未能建立线性回归方程；2、从EMR组研究结果来看，除了CDFI方法测得的结果没有统计学意义外(r值均小于0.39，p值均大于0.05)，其他三种方法与连续方程法比较均有明显相关性(r值均大于0.78，p值均小于0.05)，并建立了直线回归方程。【结论】1、由于本研究的纳入及剔除标准较为严格，致进入CMR组的病例数较少，未能发现有价值的研究结果，也不能作为EMR组的对照组进行方法学评价，但只要进一步扩大样本量，这一问题可望得到解决；2、从EMR研究结果来看，除了CDFI方法测得的结果没有统计学意义外，其他如PISA、VC、3D和连续方程法比较均有明显相关性，并建立了直线回归方程；其中又以3D测值的相关性最佳，在临床上有较广阔的应用前景。但这四种方法均有各自的一些不
[Objective] To evaluate the value of the a few measurements of color Doppler echocardiography in quantitative diagnosis of eccentric mitral regurgitation (EMR) . [Methods] 63 patients with EMR and 11 patients with central mitral regurgitation (CMR) were studied respectively with the continuity equation method, color Doppler flow imaging (CDFI) , proximal isovelocity surface area method (PISA) ,the Vena Contracta (VC) and real-time three dimensional color Doppler method (3D) . And those results were analyzed in their correlation and regression based on the continuity equation method as a "reference standard" and mutually compared between the EMR and the CMR. [Results] 1 .In CMR group, compared the results of the four methods to the results of continuity equation method, their correlation is not significant (r value all less than 0.65, p value all more than 0.05) . So we couldn't built a regression equation between them; 2. In EMR group, except the results of CDFI had not been found the statistical significance(r<0.39,p>0.05), the results of the other three methods all been found to have significant correlations with the results of continuity equation method (r value all more than 0.78, p value all less than 0.05) , and been established the regression equations between them. [Conclusions] 1、 Because of selective and eliminated criterions were rigid, the sample of CMR patients was small and we neither find the valuable results nor compared the results of EMR with them. By adding the sample of CMR group, this
[Objective] To evaluate the value of the a few measurements of color Doppler echocardiography in quantitative diagnosis of eccentric mitral regurgitation (EMR) . [Methods] 63 patients with EMR and 11 patients with central mitral regurgitation (CMR) were studied respectively with the continuity equation method, color Doppler flow imaging (CDFI) , proximal isovelocity surface area method (PISA) ,the Vena Contracta (VC) and real-time three dimensional color Doppler method (3D) . And those results were analyzed in their correlation and regression based on the continuity equation method as a "reference standard" and mutually compared between the EMR and the CMR. [Results] 1 .In CMR group, compared the results of the four methods to the results of continuity equation method, their correlation is not significant (r value all less than 0.65, p value all more than 0.05) . So we couldn't built a regression equation between them; 2. In EMR group, except the results of CDFI had not been found the statistical significance(r<0.39,p>0.05), the results of the other three methods all been found to have significant correlations with the results of continuity equation method (r value all more than 0.78, p value all less than 0.05) , and been established the regression equations between them. [Conclusions] 1、 Because of selective and eliminated criterions were rigid, the sample of CMR patients was small and we neither find the valuable results nor compared the results of EMR with them. By adding the sample of CMR group, this
引文
1. Otsuji Y, Handschumacher MD, Kisaunuki A, et al, Functional mitral regurgitation [J]. Cardiologia,1998,43 (10): 1011-1016.
2. Enriquez-Sarano M, Freeman WK, Tribouilloy CM, ey al, Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography [J]. Am Coll Cardiol,1999,34 (4): 1129-1136.
3. Thomson HL, Enriquez-sarano M, Tajik J. Timing of surgery in patients with chronic, severe mitral regurgitation, Cardiol in Review,2001,9 (3): 137-143.
4．毛焕光，曹林省主编，心脏病学[M]，第2版，北京：人民卫生出版社，2001．939．
5. Enriquez-Sarano M, Tajik AJ, Bailey KR, et al, Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: influence of eccentricity of jet and mechanism of regurgitation. J Am Coll Cardiol,1993,21(5), 1211-1219.
6. Smith MD, Kwan OL, Spain MG, et al, Temporal variability of color Doppler jet areas in patients with mitral and aortic regurgitation. Am Heart J.1992;123 (4 Pt 1): 953-960.
7. Tokuyama A, Suzuki M, Machii K. Continuity of normal and prolapsed mitral valves: two-dimensional and color Doppler echocardiographic investigations.J Cardiol Suppl. 1988; 18: 21-28
8. Schmidt A, Pazin-Filho A, Almeida-Filho OC, et al, Effects of blood viscosity on proximal flow convergence calculations of regurgitant flow rate and jet dimensions as evaluated by color Doppler flow mapping: an in vitro study. J Am Soc Echocardiogr. 2001; 14 (6): 569-79.
9. Bacher H, Mintert C, Grube E, et al. Assessment of the seventy of mitral valve insufficiency using color Doppler echocardiography. Z Kardiol. 1989; 78 (12): 764-70.
10. Shiota T, Jones M, Teien DE, et al, Evaluation of mitral regurgitation using a digitally determined color Doppler flow convergence 'centerline' acceleration method. Studies in an animal model with quantified mitral regurgitation. Circulation, 1994,89,2879-2887.
11. Richards KL, Cannon SR, Miller JF, eta. Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation. Circulation. 1986; 73 (5) :964-969.
12. Chen C, Thomas J, Anconina J, et al. Impact of impinging wall jet on color Doppler quantification ofmitral regurgitation. Circulation 1991;84 (2) :712-720.
13. Triboulloy C,Shen WF, Slama MA, et al, Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation. Br Heart J, 1991,66 (4) :290-294.
14. Enriquez-Sarano M, Bailey KR, Seward JB, et al.Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993,87: 841-848.
15. Dubin J, Wallerson DC, Cody RJ, et al. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J. 1990; 120 (1): 116-123.
16．戴振林，沈卫峰，于金德等，超声多普勒测定二尖瓣反流的有效返流口面积，金陵医院学报．1996，9(1)，6-8．
17. Blumlein S, Bouchard A, Schiller NB, et al, Quantitation of mitral regurgitation by Doppler echocardiography. Circultaion, 1986, 74 (2), 306-314.
18．袁莉，谢明星，王新房等，实时三维彩色多普勒超声评价偏心性二尖瓣反流量的初步探讨，中华超声影像学杂，2005，14(3)，165-169．
19. Shiota T, Jones M, Valdes-Cruz LM, et al. Color flow Doppler determination of transmitral flow and orifice area in mitral stenosis: experimental evaluation of the proximal flow-convergence method. Am Heart J. 1995; 129 (1): 114-123.
20. Rifkin RD, Harper K, Tighe D, Comparison of proximal isovelocity surface area method with pressure half-time and planimetry in evaluation of mitral stenosis. J Am Coll Cardiol. 1995; 26 (2): 458-65.
21. Sitges M, Jones M, Shiota T, et al. Interaliasing distance of the flow convergence surface for determining mitral regurgitant volume: a validation study in a chronic animal model. J Am Coll Cardiol. 2001; 38 (4): 1195-1202.
22．叶军，杨心华，游宇光等，彩色多普勒血流汇聚法定量评估二尖瓣反流的研究，中国超声诊断杂志，2003，4(8)，588-589．
23. Recusani F, Bargiggia GS, Yoganathan AP, et al, A new method for quantification of regurgitant flow rote using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study. Circulation, 1991; 83(2): 594-604.
24. Bargiggia CS, Tronconi L, Sahn DJ, et al. A new method for quantification of mitral regurgitation based on color Doppler flow imaging of flow convergence proximal to regurgitation orifice. Circulation, 1991, 84: 1481-1489.
25. Mele D, Schwammenthal E, Torp H, et al, A semiautomated objective technique for applying the proximal isovelocity surface area method to quantitate mitral regurgitation: Clinical studies with the digital flow map. Am Heart J, 2001, 141(4): 653-660.
26. Grossmann G, Marx N,Spiess J,et al, Value of the proximal flow convergence method for quantification of the regurgitant volume in mitral regurgitation Influence of the mechanism of regurgitation, the imaging of the flow convergence region, and different calculation modalities,Z Kardiol,2004,93 (12), 944-953.
27．陆爱华，金奇，彩色多普勒血流汇聚法对偏心性二尖瓣返流程度的评估，江苏临床医学杂志，2002，6(5)，441-442．
28．叶军，杨心华，游宇光等，彩色多普勒血流汇聚法定量评估二尖瓣返流的研究，中国超声诊断杂志，2003，4(8)，588-589．
29. Reimold SC, Ganz P, Bitde JA, et al. Effective aortic regurgitant orifice area: description of a method based on the conservation of mass. J Am Coll Cardiol, 1991, 18: 761-768.
30. Vandervoort PM, Rivera JM, Mele D, et al. Application of color Doppler flow mapping to calculate effective regurgitant orifice area. An in vitro study and initial clinical observations. Circulation, 1993, 88: 1152-1156.
31. Thomas J, Liu C, Flachskampf F, et al, Quantitation of jet flow by momentum analysis: an in vitro color Doppler flow study. Circulation,1990, 81: 247-259.
32．陆爱华，金奇，彩色多普勒血流汇聚法对偏心性二尖瓣反流程度的评估，江苏临床医学杂志，2002，6(5)，441-442．
33. Ishii M, Jones M,Shiota T, et al. Quantifying Aortic Regurgitation by Using the Color Doppler-imaged Vena Contracta. A chronicanimal model study. Circulation. 1997, 96: 2009-2015.
34. Yoganarhan AP, Cape EG, Sing HW, et al, Review of hydrodynamic principles for the cardiologist: applications to the study of blood flow and jets by imaging techniques. J Am Coll Cardiol, 1988, 12: 1344-1353.
35. Shita T, Jones M, Agler DA, et al. New echocardiographic windows for quantitative determination of aortic regurgitation volume using color Doppler flow convergence and vena contracta. Am J Cardiol, 1999, 83: 1064-1068.
36. Khanna D, Vengala S, Miller AP, et al, Quantification ofmitral regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area, Echocardiography,2004,21 (8) ,737-743.
37. Zhou XD, Jones M, Shirota T, et al. Vena contracta imaged by Doppler color flow mapping predicts the severity of eccentric mitral regurgitation better than color jet area: a chronic animal study. J Am Coll Cardiol,1997,30:1393-1398.
38. Hall SA, Briceer ME, Willet DWL, et al. Assessment of Mitral Regurgitation Severity by Doppler Color Flow Mapping of the Vena Contracta, Circulation, 1997,95:636-642.
39. Baumgartner H, Schima H, Kuhn P. Value and limitations of proximal jet dimensions for the quantitation of valvular regurgitation: an in vitro study using Doppler flow imaging.J Am Soc Echocardiogr. 1991;4 (1) :57-66.
40. Delabays A, Shiota T, Teien D, et al. Three-dimensional echocardiography allows accurate quantitation of the vena contracta and mitral regurgitation flow rates for asymmetric orifice: an in vitro validation study. Circulation, 1995,92 ( Suppl I) :I-798.
41. Mori Y, Shiota T, Jones M, et al. Three-dimensional reconstruction of the color Doppler-imaged vena contracta for quantifying aortic regurgitation: shudies in a chronic animal modeal. Circulation, 1999,99:1611-1617.
42. Thomas B,Ronald A M,J.Luis G,et al,The Power-Velocity integral at the Vena Contracta. Circulation.2000,102 (9) ,1053-1061.
43. Roberts BJ, Grayburn PA. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations. J Am Soc Echocardiogr. 2003 , 16(9) :1002-1006.
44. Lesniak-Sobelga A,Olszowaka M,Pienazek P,et al,Vena contracta width as a simple method of assessing mitral valve regurgitation.Comparision with Doppler qualitative methods,J Heart Valve Dis.2004,13 (4) ,608-614.
45. Dekker DL. Piziah RL, Dong E Jr. A system for ultrasonically imaging the human heart in three dimensions. Comput Biomed Res, 1974, 7: 544-553.
46. Moritz WE, Pearlman AS, McCabe DH, et al, An ultrasonic technique for imaging the ventricle in three dimensions and calculating its volume. IEEE Trans Biomed Eng, 1983, BME-30: 488-491.
47. Picot PA, Rickey DW, Mitchell R, et al. Three-dimensional colour Doppler imaging. Ultrasound Med Biol. 1993; 19 (2): 95-104.
48. Belohlavek M, Foley DA, Ferber TC, et al. Three-and four-dimensional cardiovascular ultrasound imaging: A new era for echocardiography. Mayo Clin Proc. 1993. 68: 221-240.
49．王新房，实时三维超声心动图——超声技术领域内的新突破，中华超声影像学杂志，2003，12(2)，71-75．
50. Picot PA, Rickey DW, Mitchell R, et al. Three-dimensional colour Doppler imaging. Ultrasound Med Biol. 1993; 19 (2): 95-104.
51. Robert A, Levine, et al. Three-dimensional echocardiographic reconstruction of the mitml valve, with implication for the diagnosis of mitral valve prolopse. Circulation,1989, 80: 589.
52. T Irvine, X N Li, R Rusk, et al. Three dimensional colour Doppler echocardiography for the characterization and quantification of cardiac flow events. Heart, 2000, 84 (suppl Ⅱ): ⅱ2-ⅱ6.
53. Omid S, Kwan LC, Impact for three-dimensional echocardiography in valvular heart disease. Current Opinion in Cardio, 2005, 20: 122-126.
54. Sutaria N, Northridge D, Masani N, Three dimensional echocardiography for the assessment of mitral valve disease. Heart,2000,84 (suppl Ⅱ): ⅱ7-ⅱ10.
55. Sahn DJ. Instrumentation and physical factors related to visualization of stenotic and regurgitant jets by Doppler color flow mapping. J Am Coll Cardiol,1998,12:1354-1365.
56. Thomas L, Foster E, Hoffman JI, et al. The mitral regurgitation index: an echocardiographic guide to severity. J Am Coll Cardiol,1999;33 (7) :2016.
57. Ralchelen JS, Tnvedi SS, Herman GT, et al. Dynamic three-dimensional echocardiograms. J Am Coll Cardiol, 1986,8:364-370.
2. Enriquez-Sarano M, Freeman WK, Tribouilloy CM, ey al, Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography [J]. Am Coll Cardiol,1999,34 (4): 1129-1136.
3. Thomson HL, Enriquez-sarano M, Tajik J. Timing of surgery in patients with chronic, severe mitral regurgitation, Cardiol in Review,2001,9 (3): 137-143.
4．毛焕光，曹林省主编，心脏病学[M]，第2版，北京：人民卫生出版社，2001．939．
5. Enriquez-Sarano M, Tajik AJ, Bailey KR, et al, Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: influence of eccentricity of jet and mechanism of regurgitation. J Am Coll Cardiol,1993,21(5), 1211-1219.
6. Smith MD, Kwan OL, Spain MG, et al, Temporal variability of color Doppler jet areas in patients with mitral and aortic regurgitation. Am Heart J.1992;123 (4 Pt 1): 953-960.
7. Tokuyama A, Suzuki M, Machii K. Continuity of normal and prolapsed mitral valves: two-dimensional and color Doppler echocardiographic investigations.J Cardiol Suppl. 1988; 18: 21-28
8. Schmidt A, Pazin-Filho A, Almeida-Filho OC, et al, Effects of blood viscosity on proximal flow convergence calculations of regurgitant flow rate and jet dimensions as evaluated by color Doppler flow mapping: an in vitro study. J Am Soc Echocardiogr. 2001; 14 (6): 569-79.
9. Bacher H, Mintert C, Grube E, et al. Assessment of the seventy of mitral valve insufficiency using color Doppler echocardiography. Z Kardiol. 1989; 78 (12): 764-70.
10. Shiota T, Jones M, Teien DE, et al, Evaluation of mitral regurgitation using a digitally determined color Doppler flow convergence 'centerline' acceleration method. Studies in an animal model with quantified mitral regurgitation. Circulation, 1994,89,2879-2887.
11. Richards KL, Cannon SR, Miller JF, eta. Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation. Circulation. 1986; 73 (5) :964-969.
12. Chen C, Thomas J, Anconina J, et al. Impact of impinging wall jet on color Doppler quantification ofmitral regurgitation. Circulation 1991;84 (2) :712-720.
13. Triboulloy C,Shen WF, Slama MA, et al, Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation. Br Heart J, 1991,66 (4) :290-294.
14. Enriquez-Sarano M, Bailey KR, Seward JB, et al.Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993,87: 841-848.
15. Dubin J, Wallerson DC, Cody RJ, et al. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J. 1990; 120 (1): 116-123.
16．戴振林，沈卫峰，于金德等，超声多普勒测定二尖瓣反流的有效返流口面积，金陵医院学报．1996，9(1)，6-8．
17. Blumlein S, Bouchard A, Schiller NB, et al, Quantitation of mitral regurgitation by Doppler echocardiography. Circultaion, 1986, 74 (2), 306-314.
18．袁莉，谢明星，王新房等，实时三维彩色多普勒超声评价偏心性二尖瓣反流量的初步探讨，中华超声影像学杂，2005，14(3)，165-169．
19. Shiota T, Jones M, Valdes-Cruz LM, et al. Color flow Doppler determination of transmitral flow and orifice area in mitral stenosis: experimental evaluation of the proximal flow-convergence method. Am Heart J. 1995; 129 (1): 114-123.
20. Rifkin RD, Harper K, Tighe D, Comparison of proximal isovelocity surface area method with pressure half-time and planimetry in evaluation of mitral stenosis. J Am Coll Cardiol. 1995; 26 (2): 458-65.
21. Sitges M, Jones M, Shiota T, et al. Interaliasing distance of the flow convergence surface for determining mitral regurgitant volume: a validation study in a chronic animal model. J Am Coll Cardiol. 2001; 38 (4): 1195-1202.
22．叶军，杨心华，游宇光等，彩色多普勒血流汇聚法定量评估二尖瓣反流的研究，中国超声诊断杂志，2003，4(8)，588-589．
23. Recusani F, Bargiggia GS, Yoganathan AP, et al, A new method for quantification of regurgitant flow rote using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study. Circulation, 1991; 83(2): 594-604.
24. Bargiggia CS, Tronconi L, Sahn DJ, et al. A new method for quantification of mitral regurgitation based on color Doppler flow imaging of flow convergence proximal to regurgitation orifice. Circulation, 1991, 84: 1481-1489.
25. Mele D, Schwammenthal E, Torp H, et al, A semiautomated objective technique for applying the proximal isovelocity surface area method to quantitate mitral regurgitation: Clinical studies with the digital flow map. Am Heart J, 2001, 141(4): 653-660.
26. Grossmann G, Marx N,Spiess J,et al, Value of the proximal flow convergence method for quantification of the regurgitant volume in mitral regurgitation Influence of the mechanism of regurgitation, the imaging of the flow convergence region, and different calculation modalities,Z Kardiol,2004,93 (12), 944-953.
27．陆爱华，金奇，彩色多普勒血流汇聚法对偏心性二尖瓣返流程度的评估，江苏临床医学杂志，2002，6(5)，441-442．
28．叶军，杨心华，游宇光等，彩色多普勒血流汇聚法定量评估二尖瓣返流的研究，中国超声诊断杂志，2003，4(8)，588-589．
29. Reimold SC, Ganz P, Bitde JA, et al. Effective aortic regurgitant orifice area: description of a method based on the conservation of mass. J Am Coll Cardiol, 1991, 18: 761-768.
30. Vandervoort PM, Rivera JM, Mele D, et al. Application of color Doppler flow mapping to calculate effective regurgitant orifice area. An in vitro study and initial clinical observations. Circulation, 1993, 88: 1152-1156.
31. Thomas J, Liu C, Flachskampf F, et al, Quantitation of jet flow by momentum analysis: an in vitro color Doppler flow study. Circulation,1990, 81: 247-259.
32．陆爱华，金奇，彩色多普勒血流汇聚法对偏心性二尖瓣反流程度的评估，江苏临床医学杂志，2002，6(5)，441-442．
33. Ishii M, Jones M,Shiota T, et al. Quantifying Aortic Regurgitation by Using the Color Doppler-imaged Vena Contracta. A chronicanimal model study. Circulation. 1997, 96: 2009-2015.
34. Yoganarhan AP, Cape EG, Sing HW, et al, Review of hydrodynamic principles for the cardiologist: applications to the study of blood flow and jets by imaging techniques. J Am Coll Cardiol, 1988, 12: 1344-1353.
35. Shita T, Jones M, Agler DA, et al. New echocardiographic windows for quantitative determination of aortic regurgitation volume using color Doppler flow convergence and vena contracta. Am J Cardiol, 1999, 83: 1064-1068.
36. Khanna D, Vengala S, Miller AP, et al, Quantification ofmitral regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area, Echocardiography,2004,21 (8) ,737-743.
37. Zhou XD, Jones M, Shirota T, et al. Vena contracta imaged by Doppler color flow mapping predicts the severity of eccentric mitral regurgitation better than color jet area: a chronic animal study. J Am Coll Cardiol,1997,30:1393-1398.
38. Hall SA, Briceer ME, Willet DWL, et al. Assessment of Mitral Regurgitation Severity by Doppler Color Flow Mapping of the Vena Contracta, Circulation, 1997,95:636-642.
39. Baumgartner H, Schima H, Kuhn P. Value and limitations of proximal jet dimensions for the quantitation of valvular regurgitation: an in vitro study using Doppler flow imaging.J Am Soc Echocardiogr. 1991;4 (1) :57-66.
40. Delabays A, Shiota T, Teien D, et al. Three-dimensional echocardiography allows accurate quantitation of the vena contracta and mitral regurgitation flow rates for asymmetric orifice: an in vitro validation study. Circulation, 1995,92 ( Suppl I) :I-798.
41. Mori Y, Shiota T, Jones M, et al. Three-dimensional reconstruction of the color Doppler-imaged vena contracta for quantifying aortic regurgitation: shudies in a chronic animal modeal. Circulation, 1999,99:1611-1617.
42. Thomas B,Ronald A M,J.Luis G,et al,The Power-Velocity integral at the Vena Contracta. Circulation.2000,102 (9) ,1053-1061.
43. Roberts BJ, Grayburn PA. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations. J Am Soc Echocardiogr. 2003 , 16(9) :1002-1006.
44. Lesniak-Sobelga A,Olszowaka M,Pienazek P,et al,Vena contracta width as a simple method of assessing mitral valve regurgitation.Comparision with Doppler qualitative methods,J Heart Valve Dis.2004,13 (4) ,608-614.
45. Dekker DL. Piziah RL, Dong E Jr. A system for ultrasonically imaging the human heart in three dimensions. Comput Biomed Res, 1974, 7: 544-553.
46. Moritz WE, Pearlman AS, McCabe DH, et al, An ultrasonic technique for imaging the ventricle in three dimensions and calculating its volume. IEEE Trans Biomed Eng, 1983, BME-30: 488-491.
47. Picot PA, Rickey DW, Mitchell R, et al. Three-dimensional colour Doppler imaging. Ultrasound Med Biol. 1993; 19 (2): 95-104.
48. Belohlavek M, Foley DA, Ferber TC, et al. Three-and four-dimensional cardiovascular ultrasound imaging: A new era for echocardiography. Mayo Clin Proc. 1993. 68: 221-240.
49．王新房，实时三维超声心动图——超声技术领域内的新突破，中华超声影像学杂志，2003，12(2)，71-75．
50. Picot PA, Rickey DW, Mitchell R, et al. Three-dimensional colour Doppler imaging. Ultrasound Med Biol. 1993; 19 (2): 95-104.
51. Robert A, Levine, et al. Three-dimensional echocardiographic reconstruction of the mitml valve, with implication for the diagnosis of mitral valve prolopse. Circulation,1989, 80: 589.
52. T Irvine, X N Li, R Rusk, et al. Three dimensional colour Doppler echocardiography for the characterization and quantification of cardiac flow events. Heart, 2000, 84 (suppl Ⅱ): ⅱ2-ⅱ6.
53. Omid S, Kwan LC, Impact for three-dimensional echocardiography in valvular heart disease. Current Opinion in Cardio, 2005, 20: 122-126.
54. Sutaria N, Northridge D, Masani N, Three dimensional echocardiography for the assessment of mitral valve disease. Heart,2000,84 (suppl Ⅱ): ⅱ7-ⅱ10.
55. Sahn DJ. Instrumentation and physical factors related to visualization of stenotic and regurgitant jets by Doppler color flow mapping. J Am Coll Cardiol,1998,12:1354-1365.
56. Thomas L, Foster E, Hoffman JI, et al. The mitral regurgitation index: an echocardiographic guide to severity. J Am Coll Cardiol,1999;33 (7) :2016.
57. Ralchelen JS, Tnvedi SS, Herman GT, et al. Dynamic three-dimensional echocardiograms. J Am Coll Cardiol, 1986,8:364-370.
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