术前经胸及经食管超声心动图在二尖瓣修复术中的应用  

The value of transthoracic and transesophageal echocardiography in mitral valve repair

作　　者：黄国倩[1] 潘翠珍[1] 舒先红[1] 刘诗珍[1] 陈海燕[1] 陈灏珠[1] 

机构地区：[1]复旦大学附属中山医院心超室-上海市心血管病研究所,上海200032

出　　处：《复旦学报（医学版）》2007年第5期696-700,共5页Fudan University Journal of Medical Sciences

摘　　要：目的对二尖瓣修复术前运用经胸及经食管超声心动图技术诊断二尖瓣反流(mitral regurgitation,MR)病变的精确度进行比较。方法2004年3月至2006年6月,我院共有243例MR患者拟行二尖瓣修复术。术前所有患者均行经胸超声心动图(transthoracic echocardiography,TTE)检查,41例患者行经食管超声心动图(transeophageal echocardiography,TEE)检查。将术前超声心动图资料与术中所见进行比较,分别对TTE及TEE的诊断精确度进行评价。结果术前TTE及TEE与手术吻合率分别为81.48%及87.80%(P=0.325)。TTE与TEE的诊断吻合率为73.17%。两种技术检测脱垂、腱索断裂、瓣膜穿孔或裂缺、腱索异常以及赘生物等病变的敏感性、特异性以及诊断精确度无统计学差异。8例患者行换瓣术,其余235例行二尖瓣修复术。术前是否接受TEE检查对修复成功率无显著影响。结论TTE是检测各种二尖瓣反流性病变的有效手段,能满足绝大多数患者的术前诊断需要,在MVR中具有重要的应用价值。Purpose To evaluate the diagnosis accuracy of mitral regurgitant （MR） lesions assessed by transthoracic echocardiography （TTE） and transesophageal echocardiography （TEE）. Methods Between March 2004 and June 2006, 243 consecutive patients were planned to undergo mitral valve repair （150 men, 93 women; mean age 50 ± 16 years）. All patients underwent TTE examination and 41 patients underwent TEE. Their accuracy in detecting of MR lesions was evaluated against surgical findings. Results The agreement with surgical findings was 81.48% for TTE and 87.80% for TEE （P = 0. 325）. The accordance between TTE and TEE was 73.17%. There is no difference in sensi- tivity, specificity and diagnosis accuracy between TTE and TEE for detecting all types of MR lesions （prolapse, ruptured chordae, perforation or cleft, chordae abnormity, vegetation）. Mitral valve replacement was performed in 8 patients; the other 235 underwent mitral valve repair. Preoperative TEE had no influence on the successful rate of mitral valve repair. Conclusions TTE provides a highly accurate anatomic and function assessment of MR lesions with equal diagnosis accuracy as TEE,it is a valuable tool in mitral velve repair.

关 键 词：二尖瓣修复 二尖瓣反流 超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病]