经食管三维超声心动图评价人工二尖瓣瓣周反流  

Application of three-dimensional transesophageal echocardiography for perivalvular leak in prosthetic mitral valve

作　　者：费洪文[1,2,3] 何亚乐[1,2,3] 黄焕雷[1,2,4] 黄新胜[1,2,3] 郑智超[1,2,3] 陈欧迪[1,2,3] 陈烁[1,2,3] 

机构地区：[1]广东省心血管病研究所 [2]广东省人民医院 [3]广东省医学科学院心内科,广州510100 [4]广东省医学科学院心外科,广州510100

出　　处：《中华临床医师杂志（电子版）》2012年第3期28-31,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广东省医学科研基金(A2009044)

摘　　要：目的探讨经食管三维超声心动图评价人工二尖瓣术后瓣周反流的可行性、准确性。方法 2007年12月至2011年8月本心脏中心因二尖瓣置换术后瓣周反流行再次心脏手术的病例24例,男17例,女7例,年龄30～65岁,平均(48±9)岁,24例均术前行经胸二维超声检查,11例行经食管二维超声检查,9例行经食管三维超声检查。以外科术中所见为金标准,分别对比经胸二维超声、经食管二维超声、经食管三维超声评价瓣周反流存在与否、位置、程度及病因的准确性。结果经胸二维超声、经食管二维超声、经食管三维超声评价瓣周反流存在与否准确性分别为87.5%(21/24),100%(11/11),100%(9/9);判断瓣周反流位置准确性:经胸二维超声62.5%(15/24),经食管二维超声81.8%(9/11),经食管三维超声100%(9/9);判断反流程度准确性:经胸二维超声70.8%(17/24),经食管二维超声72.7%(8/11),经食管三维超声100%(9/9);判断病因准确性:经胸二维超声54.2%(13/24),经食管二维超声63.6%(7/11),经食管三维超声88.8%(8/9)。结论经食管三维超声心动图能实时提供人工二尖瓣瓣周立体信息,在评价二尖瓣置换术后瓣周反流存在与否、位置、程度、病因中起到重要作用,具有更高的准确性。Objective To explore the feasibility and accuracy of three-dimensional transesophageal echocardiography（3D TEE）in evaluating perivalvular leak（PVL）in prosthetic mitral valve.Methods From Dec 2007 to Aug 2011,24 patients with moderate to severe PVL in prosthetic mitral valve underwent second heart surgery,17 male and 7 female,age from 30 to 65 years,average（48±9）years.24 cases underwent two-dimensional transthoracic echocardiography（2D TTE）,11 cases with two-dimensional transesophageal echocardiography（2D TEE）,9 cases with 3D TEE.Using surgical view as gold standard,the accuracy of 2D TTE,2D TEE and 3D TEE for existence,location,severity and cause of PVL were compared.Results The accuracy of 2D TTE,2D TEE,3D TEE for PVL existence were 87.5%（21/24）,100%（11/11） and 100%（9/9）,accuracy for PVL location were 62.5%（15/24）,81.8%（9/11）,100%（9/9）,accuracy for PVL severity were 70.8%（17/24）,72.7%（8/11）and 100%（9/9）,accuracy for PVL cause were 54.2%（13/24）,63.6%（7/11）and 88.8%（8/9）.Conclusions 3D TEE can afford live volume information for perivalvular anatomy in prosthetic mitral valve and play important role in evaluating existence,location,severity and cause of perivalvular leak in prosthetic mitral valve with high accuracy.

关 键 词：超声心动描记术 经食管 心脏瓣膜 人工 瓣周反流 

分 类 号：R540.45[医药卫生—心血管疾病]