实时三维经食管超声心动图诊断二尖瓣置换术后瓣周漏的价值及其治疗效果的对比分析  

Real-time three-dimensional transesophageal echocardiography in the diagnosis of paravalvular leakage after mitral valve replacement and a comparative analysis of treatment effect

作　　者：李师淼 李冰震 易弼顺 田锋 马柏强[1] LI Shimiao;LI Bingzhen;YI Bishun;TIAN Feng;MA Baiqiang(Department of Emergency Trauma Surgery,Lishui People’s Hospital,Zhejiang 323000,China)

机构地区：[1]浙江省丽水市人民医院急诊创伤外科,323000

出　　处：《临床超声医学杂志》2022年第12期906-910,共5页Journal of Clinical Ultrasound in Medicine

基　　金：丽水市科技计划项目(2021SJZC027)。

摘　　要：目的 探讨实时三维经食管超声心动图(RT 3D-TEE)在二尖瓣置换术后瓣周漏诊断中的价值,对比分析介入封堵术与外科手术对其的治疗效果。方法 选取我院收治的105例二尖瓣置换术后疑似瓣周漏患者,以介入封堵术或外科手术结果为金标准,确诊为瓣周漏共56例(后叶漏34例、前叶漏22例),术前均行二维经食管超声心动图(2D-TEE)和RT 3D-TEE检查,比较两种方法检查结果与金标准的一致性,以及漏口位置及漏口长度、宽度、面积的检出情况。绘制受试者工作特征(ROC)曲线评估2D-TEE、RT 3D-TEE诊断瓣周漏的效能。56例瓣周漏患者根据不同治疗方法进一步分为介入封堵组28例和外科手术组28例,比较两组术前和术后6个月左室射血分数(LVEF)、左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、左室内径(LVD),以及两组手术时间、住院费用、住院时间及输血、肺部感染、新发心律失常、残余瓣周漏占比的差异。结果 105例疑似瓣周漏患者中,2D-TEE准确检出39例,敏感性、特异性、准确率分别为69.64%、69.39%、69.52%,与金标准的一致性较差(Kappa=0.389,P<0.001);RT 3D-TEE准确检出54例,敏感性、特异性、准确率分别为96.43%、95.92%、96.19%,与金标准的一致性好(Kappa=0.923,P<0.001)。RT 3D-TEE检出后叶漏、前叶漏占比均高于2D-TEE,且漏口长度、宽度、面积均大于2D-TEE,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,2D-TEE、RT 3D-TEE诊断二尖瓣置换术后瓣周漏的曲线下面积分别为0.690、0.955,二者比较差异有统计学意义(Z=5.336,P<0.05)。介入封堵组患者术前和术后6个月LVEF、LVIDd、LVIDs、LVD与外科手术组比较差异均无统计学意义,手术时间、住院费用、住院时间及输血、肺部感染、新发心律失常占比均低于外科手术组,差异均有统计学意义(均P<0.05)。结论 RT 3D-TEE在二尖瓣置换术后瓣周漏诊断中具有较高价值;介入封�Objective To investigate the value of real-time three-dimensional transesophageal echocardiography(RT3D-TEE) in the diagnosis of paravalvular leakage(PVL) after mitral valve replacement,and to compare the effect of interventional closure and surgical treatment.Methods A total of 105 patients with suspected PVL after mitral valve replacement were selected,taking surgery(interventional occlusion,surgery) as the gold standard,56 cases of PVL after operation(34 cases of posterior lobe leakage and 22 cases of anterior lobe leakage) were comfired,and two-dimensional echocardiography(2D-TEE)and RT 3D-TEE were performed before operation,the consistency of the two methods to the gold standard were compared. The location of PVL and the length,width and area of leakage were recorded. Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of 2D-TEE and RT 3D-TEE in the diagnosis of PVL.56 patients with PVL were divided into interventional occlusion group(n=28)and surgery group(n=28)according to different treatment methods,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVIDd),left ventricular end-systolic diameter(LVIDs),left atrial diameter(LVD)before and 6 months after surgery,operation time,hospitalization cost,hospitalization time and the proportion of blood transfusion,pulmonary infection,new-onset arrhythmia,residual PVL were compared between the two groups.Results Among 105 patients with suspected PVL,39 cases were accurately detected by 2D-TEE,the sensitivity,specificity and accuracy were 69.64%,69.39%,69.52%,respectively. Compared with the gold standard,the consistency was poor(Kappa=0.389,P<0.001).54 cases were accurately detected by RT 3D-TEE,the sensitivity,specificity and accuracy were 96.43%,95.92%,96.19%,respectively.Compared with the gold standard,the consistency was good(Kappa=0.923,P<0.001).The proportion of posterior lobe leakage and anterior lobe leakage by RT 3D-TEE was higher than that of 2D-TEE,and the length,width and area of the leakage were hi

关 键 词：超声心动描记术 经食管 三维 实时 二尖瓣置换术 瓣周漏 介入封堵 外科手术 

分 类 号：R540.45[医药卫生—心血管疾病]