实时三维经食管超声心动图诊断二尖瓣乳头肌断裂

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PMR 2例，后内侧PMR 23例；完全型PMR 1例，部分型PMR 24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PMR 23例，TTE诊断PMR 20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。

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

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.