先天性二尖瓣关闭不全的超声心动图诊断方法及准确性  

Diagnostic approach and accuracy of echocardiography in congenital mitral insufficiency

作　　者：张冰 高一鸣 张丽 徐楠 邢佳怡 张婷婷 毛凤群 李守军 逄坤静 ZHANG Bing;GAO Yiming;ZHANG Li;XU Nan;XING Jiayi;ZHANG Tingting;MAO Fengqun;LI Shoujun;PANG Kunjing(Department of Echocardiography,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,China;Pediatric Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心阜外医院超声影像中心,北京100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心阜外医院小儿心脏外科中心

出　　处：《临床心血管病杂志》2022年第12期941-945,共5页Journal of Clinical Cardiology

摘　　要：目的分析先天性二尖瓣关闭不全(CMI)超声心动图影像特征,以外科手术探查结果为金标准,探讨超声心动图对CMI的诊断方法及诊断准确性。方法回顾性分析2016年10月—2022年4月于阜外医院行超声心动图检查诊断为中度及以上的儿童CMI患者,均行二维及三维超声心动图对二尖瓣关闭不全的病理结构、反流程度进行了定性及定量诊断。以外科手术探查结果为金标准,探讨超声心动图诊断CMI的准确性,总结超声心动图对于CMI的诊断方法和评估要点。结果研究共纳入130例儿童CMI患者,超声诊断二尖瓣病理结构包括二尖瓣腱索分化不良82例(63.1%),功能性二尖瓣反流21例(16.2%),缺血性二尖瓣反流14例(10.8%),二尖瓣脱垂9例(6.9%),二尖瓣瓣叶裂4例(3.1%)。以手术探查结果为金标准,超声心动图总诊断准确率94.6%。2例二尖瓣脱垂误诊为腱索分化不良,5例功能性反流漏诊了腱索异常连接。结论超声心动图检查是儿童CMI的精准诊断工具,能够有效指导外科治疗策略。Objective To analyze the echocardiographic features of congenital mitral insufficiency(CMI).The surgical exploration results were used as the gold standard,and then the diagnostic accuracy of echocardiography for CMI was discussed.Methods Children with moderate and more than moderate CMI diagnosed by echocardiography in Fuwai Hospital from October 2016 to April 2022 were analysed retrospectively.The pathological structure and severity of mitral regurgitation(MR)were evaluated qualitatively and quantitatively by two-dimensional and three-dimensional echocardiography.With reference to the surgical exploration results as the gold standard,the accuracy of echocardiography in the diagnosis of CMI was discussed,and the diagnostic methods and evaluation points of echocardiography for CMI were summarized.Results A total of 130 children with CMI were included in the study.Echocardiography showed that the mitral valve pathology consisted of undifferentiated chordae tendineae of mitral valve in 82 cases(63.1%),functional MR in 21 cases(16.2%),ischemic MR in 14 cases(10.8%),mitral valve prolapse in 9 cases(6.9%)and isolated cleft in 4 cases(3.1%).Echocardiography was found to be 94.6%accurate compared with surgical exploration results.Two cases of mitral valve prolapse were misdiagnosed as undifferentiated chordae tendineae,and 5 cases of functional regurgitation missed the diagnosis of abnormal connection of chordae tendineae.Conclusion Echocardiography is an accurate diagnostic tool for CMI in children and can be used to guide surgical treatment strategies.

关 键 词：先天性二尖瓣关闭不全 超声心动图 腱索分化不良 缺血 脱垂 

分 类 号：R541.1[医药卫生—心血管疾病]