经食管三维超声心动图在二尖瓣位感染性心内膜炎中的应用

目的评价经食管三维超声心动图（three-dimensional transesophageal echocardiography,3D-TEE）在二尖瓣位感染性心内膜炎（infective endocarditis,IE）中的应用价值。方法选择2008年6月至2012年5月期间,在广东省人民医院行超声心动图检查并结合临床诊断,最终经手术病理确诊为二尖瓣位IE患者20例为研究对象。所有患者术前均行经胸超声心动图（transthoracic echocardiography,TTE）及3D-TEE检查。以病理为金标准,比较TTE及3D-TEE对诊断心内膜受累各种表现形式的敏感性和特异性。结果手术病理证实二尖瓣位赘生物20例,合并瓣膜穿孔11例,瓣周脓肿3例,瓣膜瘤2例,人工瓣撕脱3例。TTE及3D-TEE诊断赘生物的敏感性为80%vs.90%,特异性为57%vs.86%;诊断瓣膜穿孔的敏感性为72%vs.91%,特异性为78%vs.89%;诊断瓣周脓肿的敏感性为33%vs.66%,特异性为82%vs.94%;诊断瓣膜瘤的敏感性为50%vs.100%,特异性为94%vs.94%;诊断人工瓣撕脱的敏感性及特异性均为100%。3D-TEE对赘生物的检出率均高于TTE,差异有统计学意义（P〈0.05）。结论 3D-TEE对诊断IE各种表现形式均有较高的敏感性和特异性,能准确显示赘生物位置、形态、大小及其与周围心脏结构的空间关系,对临床治疗方案的选择及预后评估有重要作用。

Application of three-dimensional transesophageal echocardiography in diagnosis of infective endocarditis associated with mitral valve

Objectives To evaluate the application of three-dimensional transesophageal echocardiography （3D-TEE） in the diagnosis of infective endocarditis （IE） associated with mitral valve. Methods From June 2008 to May 2012, there were 20 patients who underwent eehocardiography evaluation in Guangdong General Hospital due to clinical suspicion and were ultimately diagnosed as IE associated with mitral valve by surgery and pathology. Transthoracic echocardiography （TFE） and 3D-TEE were performed postoperatively for each patient. With the pathology as the gold standard, sensitivity and specificity of ~ and 3D-TEE for detection of vegetation and other patterns of manifestations were calculated. Results Totally 20 patients were uhimately confirmed as vegetation associated with mitral valve by surgery and pathology. Eleven patients were found with valve perforation, 3 with abscess, 2 with valve aneurysm and 3 with artificial valve avulsion. Sensitivity and specificity of TTE vs. 3D-TEE for detection of vegetation were 80% vs. 90% and 57% vs. 86%; those for detection of perforation were 72% vs. 91% and 78% vs. 89%; those for abscess were 33% vs. 66% and 82% vs. 94% ; those for valve aneurysm were 50% vs. 100% and 94% vs. 94% ; and those for artificial valve avulsion were both 100%. 3D TEE had higher sensitivity and specificity in detection of vegetations than TEE （P〈0.05）. Conclusions 3D TEE has higher sensitivity and specificity in detection of various patterns of manifestations of IE. It can successfully show the precise location, morphology and size of vegetations, as well as their relationship with adjacent structures, which plays a significant role in clinical therapy and prognostic assessment.