二尖瓣成形术前经食管二维超声心动图与经胸实时三维超声评价瓣膜脱垂的比较研究  

Comparative study of real time three dimensional transthoracic echocardiography and two dimensional transesophageal dchocardiography for preoperativly evaluating mitral valve prolapse

作　　者：马宁[1] 李治安[1] 

机构地区：[1]首都医科大学附属北京安贞医院超声诊断科,100029

出　　处：《中国医药》2010年第6期501-504,共4页China Medicine

摘　　要：目的 比较经胸实时三维超声心动图（RT-3D-TTE）和经食管多平面二维超声（2D-TEE）在二尖瓣脱垂成形术前评价瓣膜脱垂部位及腱索断裂的准确性.方法 96例二尖瓣脱垂并大量反流行瓣膜修复术患者,术前24 h内分别行2D-TEE和RT-3D-TTE检查,以外科术中直视下诊断为标准,分析比较2种方法对瓣膜各个分区病变及腱索断裂诊断的准确性、敏感性和特异性.结果 11例患者因RT-3D-TTE图像不好被排除在外.根据外科Carpentier二尖瓣命名原则,共680个分区被列入研究对象（包括510个瓣膜分区,170个交界）,其中108个区有病变.RT-3D-TTE 和2D-TEE对各个分区脱垂诊断的敏感性分别是：P1：50%vs25%;P2：100%vs 97%;P3：93%vs 88%;A1：67%vs 33%;A2：93%vs 89%;A3：83%vs 50%;C：83%vs 17%.对脱垂部位总的诊断的敏感性、特异性和准确性RT-3D-TTE 和2D-TEE分别是93%vs 91%、100%vs 100%、98.8%vs 98.5%.对腱索断裂诊断敏感性、特异性RT-3D-TTE和2D-TEE分别是71%vs 92%,81%vs 89%.结论 2D-TEE和RT-3D-TTE在二尖瓣成形术前诊断二尖瓣脱垂部位及腱索断裂均具有较高的敏感性、特异性.相比较,RT-3D-TTE的优越性在于对瓣膜交界和二尖瓣前后叶混合脱垂的诊断,但2D-TEE对腱索断裂的诊断准确性较RT-3D-TTE高.Objective To compare the accuracy of detecting prolapse site and raptured chorda with real time three dimensional transthoracic echocardiography （RT-3D-TIZ） and two dimensional multiplane transesophageal echocardiography （2D-TEE）in patients with mitral valve prolapse.Methods Consecutive ninety-six patients with severe mitral regurgitation due to mitral valve prolaps （MVP） were enrolled.RT-3D-ITE and 2D-TEE were used to diagnosis prolapse site and ruptured chorda 24 hours before operation.Based on surgical findings, sensitivity, specificity, and total consistent rate of RT-3D-TTE and 2D-TEE were calculated.Results Eleven patients were excluded for poor imaging quality of RT-3D-TTE.According to Carpentier＇s surgical nomenclature, 170 commissures and 510 scallops were studied.Among them, 108 sites had prolapse.Sensitivity, specificity, and total consistent rate for diagnosising prolapse site by RT-3D-TTE was 93%, 100%, 98.8% ; 2D-TEE was 91%, 100%, 98.5%.Sensitivity of diagnosising prolapse of every scallop with RT-3D-TTE was all higher that that with 2D-TEE.Sensitivity and specificity of the detection of ruptured chorda was 71% and 81% with RT-3D-TTE and was 91% and 89% with 2D-TEE.Conclusions RT-3D-TTE and 2D-TEE both have high sensitivity and specificity for diagnosis of prolapse site and detect ruptured chorda.RT-3D-TTE is superior to 2D-TEE in diagnosising prolapse located at commissure or bileaflets.However, 2D-TEE showes higher accuracy in detection ruptured chorda than RT-3D-TTE.

关 键 词：二尖瓣疾病 经胸实时三维超声 经食管超声心动图 脱垂 瓣膜成形术 

分 类 号：R542.5[医药卫生—心血管疾病]