Original Articles 승모판협착증환자에서심초음파로측정한 Abstract 승모판막넓이의정확성 : 수술중측정한 승모판막넓이와의비교 * 한창엽 김기식 한성욱 허승호 배장호 김윤년 김권배 Accuracy of Mitral Valve Area in

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1 Original Articles 승모판협착증환자에서심초음파로측정한 Abstract 승모판막넓이의정확성 : 수술중측정한 승모판막넓이와의비교 * 한창엽 김기식 한성욱 허승호 배장호 김윤년 김권배 Accuracy of Mitral Valve Area in Patients with Mitral Stenosis Measured by EchocardiographyCompared with Operative Mitral Valve Area Chang Yeob Han, M.D., Kee Sik Kim, M.D., Seong Wook Han, M.D., Seung Ho Hur, M.D., Jang Ho Bae, M.D., Yoon Nyun Kim, M.D., Kwon Bae Kim, M.D. Division of Cardiology, Department of Internal Medicine, Keimyung University, School of Medicine, Taegu, Korea BackgroundMeasurement of echocardiographic mitral valve areamva is a useful non-invasive method of estimating the stenotic mitral valve area. This study was undertaken to evaluate the accuracy of echocardiographic MVA measurements by comparing MVAs measured by the planimetric and the pressure half-time method versus direct MVA measurement by using a cone shaped device specifically made for direct measurement of MVA. Methods and ResultsThe study population consisted of 22 consecutive patients from August 1993 to February All the patients underwent 2D planimetry and Doppler echocardiographic MVA measurements before and after valve replacement surgerydirect measurement also was performed after surgery. Five patients22.7% had normal sinus rhythm, and the rest of the patients had atrial fibrillation. Two-dimensional echocardiographic examinations were attempted in 22 patients, and adequate measurements were obtained in 21 of the patients studied. Mean mitral valve area were cm ranged from 0.42 to 1.68cm on 2D planimetry method, cm ranged from 0.42 to 1.68cm on Doppler pressure half-time method, cm ranged from 0.93 to 1.68cm on direct measurement of mitral valve area after surgery. 2D planimetry methodr0.621, p0.003, SE0.165, pressure half-time methodr0.454, p0.003 SE0.187, and transmitral peak velocity r0.480, p0.026, SE0.189 was relatively well correlate with operative mitral valve area. There was relatively good agreement between direct and 2D planimetric measurements and between 교신저자 205

2 direct and Dopler pressure half-time methods. Conclusion2D planimetry and Doppler pressure half-time method on echocardiography are useful, noninvasive measurement methods in patients with mitral stenosis. KEY WORDSMitral valve area Planimetry Pressure half-time. 서 론 연구방법 1. 심초음파도를이용한측정 Table 1. Electrocardiographic and echocardiographic findings in subjects ECG NSR 522.7% AF % LADcm ) LVDdcm LVDscm Peak velocityms 연구대상 Fig. 1. 2D planimetric measurement of the mitral valve area in patients with mitral stenosis on parasternal short axis view. 206

Fig. 2. Mitral valve area, measured by pressure halftime method on continuous wave Doppler echocardiogram. 2. 수술후승모판면적의직접측정 결과 1. 이면성심초음파및 M mode 심초음파소견 Table 2.

3 Fig. 2. Mitral valve area, measured by pressure halftime method on continuous wave Doppler echocardiogram. 2. 수술후승모판면적의직접측정 결과 1. 이면성심초음파및 M mode 심초음파소견 Table 2. Associated valve abnormalities in subjects Mitral regurgitation none 10 Mild 9 moderate 1 severe 2 Aortic regurgitation none 9 grade 5 grade 7 grade 0 grade 1 Table 3. Mean mitral valve area(mva) in each methods valve area (mean cm 2 ) Surgical* ( ) Planimetry ( ) Fig. 3. Schematic diagram of device, which was used for direct measurement of mitral valve area. Pressure half time ( ) *Post-op direct measurement 207

4 2. 이면성심초음파및도플러심초음파도소견 Fig. 4. Correlation between direct measurement & echocardiographic planimetry method. Fig. 5. Correlation between direct measurement & pressure half time method. Fig. 6. Correlation between direct measurement & peak velocity of transmitral flow. Table 4. Correlation coefficient and p value between each measurement methods Surgical (n22/22) Planimetry (n21/22) PHT* (n22/22) Peak velocity (n22/22) Surgical* r1.000 r1.621 r1.454 r p. p0.003 p0.033 p Planimetry r0.621 r1.000 r0.524 r p0.002 p. p0.015 p PHT** r0.454 r1.524 r1.000 r p0.033 p0.015 p. p Peak velocity r r r r1.000 p p p P. *post-up direct measurement **PHT:pressure half time 208

5 Table 5. Correlation coefficient and p value between direct measurement and echocardiographic measurement in patients with atrial fibrillation and normal sinus rhythm Planimetry PHT* Peak velocity Surgical** AF r0.683 R0.417 r0.518 n17 p0.004 P0.096 p n1617 N1717 n 1417 NSR r0.237 R0.523 r0.465 n5 p0.401 P0.366 p n55 N55 n 45 *PHT:pressure half time **post-op direct measurement Table 6. Correlation coefficient and p value of surgical and echocardiographic parameters according to associated valvular heart disease Planimetry PHT* P. velocity Surgical** MR r r0.361 r0.589 n12 p p0.248 p MR r0.128 r0.431 r0.376 n10 p p0.214 p AR r r0.285 r0.575 n13 p p0.346 p AR r r0.684 r0.406 n9 p p0.042 p *pressure half time **post-op direct measurement Fig. 7. Difference against mean for MVA between surgical and planimetric echocardiographic measurement. 209

6 Fig. 8. Difference against mean for MVA between surgical and Doppler echocardiographic measurement. 고안 210

7 211

8 결론 요약 연구배경 : 방법 : 결과 : 212

9 결론 : References 1) Gorlin R, Gorlin SG:Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves and central circulatory shounts. I Am Heart J 41:1-29, ) Gorlin R:Calculation of cardiac valve stenosis:restoring an old concept for advanced applications. J Am Coll Cardiol 10: , ) Libanoff AJ, Rodbard S:Evaluation of the severity of mitral stenosis and regurgitation. Circulation 33: , ) Beyer RW, Olmas A, Bermudez RF, Noll HE:Mitral valve resistance as a hemodynamic indicator in mitral stenosis. Am J Cardiol 69: , ) Cope GD, Kisslo JA, Johnson ML, Behan VS:A reassessment of the echocardiogram in mitral stenosis. Circulation 52: , ) DeMaria AN, Miller RR, Amsterdam EA, Markson W, Mason DJ:Mitral valve early diastolic closing velocity in the echocardiogram:relation to sequential diastolic flow and ventricular compliance. Am J Cardiol 37: , ) Shiu MF, Jenkins BS, Webb-peploe MM:Echocardiographic analysis of posterior mitral leaflet movenment in mitral stenosis. Br Heart J 40: , ) Griffith JM, Henry WL:A sector scanner for realtime two dimensional echocardiography. Circulation 49: , ) Henry WL, Kastl DG:Echocardiographic evaluation of patients with mitral stenlosis. Am J Med 62: , ) Nichol PM, Gilbert BW, Kisslo JA:Two dimensional echocardiographic assessment of mitral stenosis. Circulation 55: , ) Wann LS, Weyman AE, Feigenbaum H, Dillon JC, Johnston KW, Eggleton RC:Determination of mitral valve area by cross sectional echocardiography. Ann Intern Med 88: , ) Martin RP, Rakowski H, Kleiman JH, Beaver W, London E, Popp RL:Reliability and reproducibility of two dimensional echocardiographic measurement of the stenotic mitral valve orifice area. Am J Cardiol 43: , ) Smith MD, Handshoe R, Handshoe S, Kwan OL, DeMaria AN:Comparative accuracy of two-dimensional echocardiography and Doppler pressure halftime methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy. Circulation 73: , ) Hatle L, Brubakk A, Tromsdal A, Angelsen B:Noninvasive assessmnent of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 40: , ) Wranne B, Ask P, Loyd D:Analysis of different methods of assessing the stenotic mitral valve area with emphasis on the pressur gradient half time concept. Am J Cardiol 66: , ) Gilon D, Cape EG, Handschumacher MD, Jiang L, Sears C, Solheim J, Morris E, Strobel JT, Miller-Jones SM, Weyman AE, Levine RA:Insights from three-dimensional echocardiographic laser streolithogrphy. Effect of leaflet funnel geometry on the coefficient of orifice contraction, pressure loss and the Gorlin formula in mitral stenosis. Circulation 94: , ) Hatle L, Angelson B, Tromsdal A:Noninvasive assessment of atrioventricular pressur half-time by Doppler ultrasound. Circulation 60: , ) Yang SS, Goldberg H:Simplified Doppler estimation of mitral valve area. Am J Cardiol 56: , ) Bryg RJ, Williams GA, Labovitz AJ, Aken U, Kennedy HL:Effect of atrial fibrillation and mitral regurgitation on calculated mitral valve area in mitral stenosis. Am J Cardiol 57: , ) Thomas JD, Wilkins GT, Choong CY, Abascal VM, Palacious IF, Block PC, Weyman AE:Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvulotomy:dependence on transmitral gradient and left atrial and ventricular compliance. Circulation 78: , ) Nakatani S, Masuyana T, Kodana K, Kitabotake A, Fujii K, Kamada T:Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve 213

10 area:comparison of the pressure half-time and continuity equation methods. Circulation 77:78-85, ) Thomas JD, Weyman AE:Doppler mitral pressure halftime:a clinical tool in search of theroretical justification. J Am Coll Cardiol 10: , ) Flachskampf FA, Weyman AE, Gillam L, Liu CM, Abscal VM, Thomas JD:Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis:clinical evidence, in vitro stimulation and theoretical analysis. J Am Coll Cardiol 16: , ) Kawahara T, Yamagish M, SEO H, Mitani M, Nakatani S, Beppu S, Nagata S, Miyakake K:Application of Doppler color flow imaging to determine valve area in mitral stenosis. J Am Coll Cardiol 18:85-92,

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<4D F736F F F696E74202D20BFA1C4DA5FC0D3BBF3C3CAC0BDC6C42E BC8A3C8AF20B8F0B5E55D> 심장 (Heart) 심초음파 서울대병원내과 김용진 심장은평생몇번이나뛸까요? 1) 3 백만번 2) 3 천만번 3) 3 억번 4) 30 억번 30 억박동, 2 억리터의혈액 Cause 심장질환 6.2 12.4 11.1 16.2 뇌졸중 4.3 8.5 7.7 11.3 기타심혈관질환 2.6 5.1 6.0 8.8 심혈관질환 13.1 26.0 24.8 36.3 총사망 50.4