实时三维经食管超声心动图诊断二尖瓣乳头肌断裂  

Real-time three-dimensional transesophageal echocardiography in diagnosis of mitral papillary muscle rupture

作　　者：李亚南 崔存英 刘园园 王莹 胡彦斌 刘瑞杰 葛振伟 赵子牛 刘琳 LI Ya′nan;CUI Cunying;LIU Yuanyuan;WANG Ying;HU Yanbin;LIU Ruijie;GE Zhenwei;ZHAO Ziniu;LIU Lin(Department of Ultrasound,Henan Province People's Hospital,Fuwai Central China Cardiovascular Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Cardiology,Henan Province People's Hospital,Fuwai Central China Cardiovascular Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院郑州大学人民医院超声科,河南郑州450003 [2]河南省人民医院阜外华中心血管病医院郑州大学人民医院心外科,河南郑州450003

出　　处：《中国医学影像技术》2019年第9期1287-1290,共4页Chinese Journal of Medical Imaging Technology

基　　金：河南省医学科技攻关计划项目(2018020452、201602173)

摘　　要：目的探讨实时三维经食管超声心动图(RT-3D-TEE)诊断二尖瓣乳头肌断裂(PMR)的临床价值。方法回顾性分析35例疑诊二尖瓣PMR患者,术前以经胸超声心动图(TTE)及RT-3D-TEE观察二尖瓣病变情况及是否合并PMR。以手术结果为金标准,计算术前RT-3D-TEE和TTE诊断二尖瓣PMR的效能。结果35例中,25例术中证实为二尖瓣PMR,包括前外侧PMR2例,后内侧PMR23例;完全型PMR1例,部分型PMR24例。10例为非二尖瓣PMR。对23例行二尖瓣位人工瓣膜置换术,2例行二尖瓣成形术。术前RT-3D-TEE诊断二尖瓣PMR23例,TTE诊断PMR20例,RT-3D-TEE诊断二尖瓣PMR符合率[92.00%(23/25)]高于TTE[80.00%(20/25),P=0.033]。RT-3D-TEE诊断PMR的敏感度、特异度、准确率、阳性预测值、阴性预测值和约登指数分别为92.00%(23/25)、100%(10/10)、94.29%(33/35)、100%(23/23)、83.33%(10/12)和0.92;术前TTE诊断二尖瓣PMR的敏感度、特异度、准确率、阳性预测值、阴性预测值及约登指数分别为80.00%(20/25)、90.00%(9/10)、82.86%(29/35)、95.24%(20/21)、64.29%(9/14)及0.70。结论RT-3D-TEE可从不同角度和层面准确提供二尖瓣解剖及病理改变的超声特征,是确诊二尖瓣PMR的有效方法,可为术前诊断、术中监测及术后评估提供可靠信息。Objective To investigate the application value of real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) for diagnosing mitral papillary muscle rupture (PMR).Methods Totally 35 patients with suspected PMR were enrolled.The mitral valve lesion and whether the lesion associated with PMR were evaluated with transthoracic echocardiography (TTE) and RT-3D-TEE preoperation.Taken surgical results as gold standards,the efficacy of preoperative RT-3D-TEE and TTE in diagnosis of mitral PMR were calculated.Results PMR was confirmed in 25 cases by cardiac surgery,including 23 cases of posteromedial PMR and 2 cases of anterolateral PMR,while complete PMR was observed in 1 case and partial PMR in 24 cases.Mitral valve replacement was performed in 23 patients,while mitral valve repairment was performed in 2 patients.Ten cases were found without mitral PMR.Preoperation RT-3D-TEE and TTE diagnosed 23 and 20 cases of PMR,respectively.The compliance rate with surgical findings were statistical different between RT-3D-TEE (92.00%[23/25]) and TTE (80.00%[20/25];P =0.033).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index of RT-3D-TEE in preoperative diagnosis of PMR was 92.00%(23/25),100%(10/10),94.29%(33/35),100%(23/23),83.33%(10/12) and 0.92,which of TTE was 80.00%(20/25),90.00%(9/10),82.86%(29/35),95.24%(20/21),64.29%(9/14) and 0.70,respectively.Conclusion RT-3D-TEE can accurately depict ultrasonic features of mitral valve anatomy and pathology from different angles and viewpoints,which is an effective method for confirming mitral PMR and providing reliable information for preoperative diagnosis,intraoperative monitoring and postoperative evaluation of PMR.

关 键 词：二尖瓣 乳头肌 超声心动描记术 三维 

分 类 号：R542.5[医药卫生—心血管疾病] R540.45[医药卫生—内科学]