International Circulation: We are here with Dr. Sarano. We have 4 questions， the first one is how to assess functional ischemic mitral regurgitation? And for the severe， should repair or replace?

　　《国际循环》：我们现在采访的是Sarano教授，有四个问题想向Sarano教授请教。第一个问题是，对于功能性缺血性二尖瓣反流，应如何进行评估？对于严重反流者，进行瓣膜修补还是置换？

　　Dr. Sarano: Thank you for the question， the way to assess is evidently by doppler echocardiography and the way we do it is not just by using color flow imaging but by doing quantitation of the mitral regurgitation using the PISA method and other methods combined to assess how much regurgitation there is and we measure the effective regurgitant orifice and the regurgitant volume knowing that we call functional mitral regurgitation when the effective regurgitant orifice is more than 20 mm2.

　　Sarano教授：感谢您的提问。很显然，评估功能性二尖瓣反流的方法是进行多普勒超声心动图检查，而且进行该检查时不能只是进行彩色血流成像还需联用PISA法及其他方法对二尖瓣反流进行定量，以评估反流量到底有多少。此外，还需测定有效反流口面积及反流量。当有效反流口面积大于20 mm2时则称之为功能性二尖瓣反流。

　　International Circulation: Thank you， the second question is how to assess functional tricuspid regurgitation?

　　《国际循环》：谢谢您的回答，第二个问题是，对于功能性三尖瓣反流，又应该如何评估？

　　Dr. Sarano: So how can we assess function tricuspid regurgitation is also by multiple approaches using Doppler echocardiography. The first step is to affirm that the tricuspid regurgitation is functional by showing that there is no organic disease of the valve. The second step is by judging how much regurgitation there is by doing the same thing， the PISA method， on the tricuspid regurgitation， not just the flow but we can also look at the reversal of the hepatic venous flow in the hepatic veins. Once we have the assessment of the tricuspid regurgitation we look at the morphology of the tricuspid valve to see if there is a predominant annular enlargement versus a predominant tenting of the tricuspid valve.

　　Sarano教授：我们可以应用多普勒超声心动图，通过多种方法对功能性三尖瓣反流进行评估。首先，要确定三尖瓣无器质性病变，确定三尖瓣反流是功能性的。其次，不仅要进行彩色血流成像，还要采用PISA法确定三尖瓣反流量。另外，还需要看肝静脉中是否存在肝静脉反向血流。此外，对三尖瓣反流进行评估时，我们还需要观察三尖瓣形态，以确定三尖瓣是否存在瓣环扩大或隆起。