经食管超声在二尖瓣成形术中的作用

目的评价多平面食管超声(TEE)在判断二尖瓣病变区域上的准确性、二尖瓣成形的效果及预测成形术能否成功等方面的作用。方法167例单纯二尖瓣反流接受瓣膜成形术患者,TEE术中全程监测,并与手术所见比较。结果TEE诊断二尖瓣叶病变区域的准确性为96.0%,而敏感性及特异性分别为94.8%和96.3%;TEE判断腱索断裂的准确性为95.8%。成形术的成功率为97.0%,失败的5例患者中,2例系手术技术原因,2例为前后叶多区域病变,另1例瓣环有明显钙化。结论TEE可准确评估二尖瓣病变的区域、腱索断裂及其部位,但对腱索断裂的根数不能准确判断;手术能否成功与瓣叶广泛的病变(至少累及3个区域)、瓣环钙化及外科医生的技术熟练程度有关。

Evaluation of transesophageal echocardiography in mitral valve repair using artificial chordae implantation

Objective To assess systematically the accuracy of transesophageal echocardiography (TEE) in identifying involvement of mitral valve(MV) segments,and to predict the result of surgery for MV repair and the factors which may cause unsuccessful repair.Methods One hundred and sixty-seven patients with isolated mitral regurgitation for MV repair were studied.TEE during the whole course of operation was performed in all patients and the results compared with surgical findings.Results The overall accuracy in identifying MV segments was 96.0% with a sensitivity of 94.8% and a specificity of 96.3% .The accuracy in diagnosing the patients with mitral chordae rupture was 95.8% .MV repair was successful in 97.0% .Two of the 5 unsuccessful repairs could be attributed to unskillful technique,and in other 3 patients there were extensive leaflet disease in 2 and calcification of mitral annulus in one.Conclusions TEE during operation provided a comprehensive assessment of MV leaflet morphology and the feasibility of repair can be predicted.The possibility of unsuccessful repair may result from those patients with extensive leaflet disease and calcification of mitral annulus.Good expertise of surgeons performing MV repair was also important.