经食管超声心动图对风湿性二尖瓣狭窄患者左心房血栓的诊断价值

目的评价经食管超声心动图对风湿性二尖瓣狭窄患者左心房血栓诊断价值。方法82例风湿性二尖瓣狭窄患者进行经胸和经食管超声心动图。结果82例患者中，29例（35％）有左心房血栓，11例位于左心房体部，14例位于左心耳，4例二部位均有；16例患者有左心房自发性超声显影征（SEC），10例患者有单纯自发性超声造影征，6例同时有左心房血栓和自发性超声造影征。4例仅有左心房体部血栓，8例仅有左心耳部血栓，2例两个部位均有血栓，8例有SEC。在3例二尖瓣狭窄合并关闭不全患者，只有1例有SEC。左心房体部和心耳血栓及自发性超声显影征均在经胸超声心动图为阴性。结论左心房血栓和SEC是风湿性心脏病二尖瓣狭窄常见并发症，经食管超声心动图是敏感和特异的检测左心房血栓和SEC方法，因此，在二尖瓣狭窄患者进行介入治疗和电除颤治疗患者选择尤其重要。

Transesophogeal echocardiography for detection of left atrial thrombus in patients with rheumatic mitral valve disease

Objective To observe the diagnostic value of transesophogeous echocardiography(TEE)for detection of left atrial thrombus in patients with rheumatic mitral valve disease.nethods Eighty-two patients with rheumatic mitral valve disease were enrolled.No anticoagulation treatment were administrated before TEE.Results Of 82 patients,29 patients(35%)had left atrial thrombus:11 in left atrial chamber,14 in left atrial appendege,and 4 in both left atrial body and left atrial appendege.16 patients had left atrial spontaneous echo contrast(SEC).10 of them had only SEC.6 had both SEC and left atrial thrombus.In 22 subgroup patients with lone mitral stenosis and atrial fibrilation,10 patients had left atrial tllrombus,8 patients had SEC.However,in 3 subgroup patients with mitral valve stenosis and regurgitation,only 1 patient had SEC.No left atrial thrombus was detected by transthoracic echocardiography.Conclusion Left atrial thrombus and SEC are common complications in patients with rheumatic mitral valve stenosis.especially with atrial fibrilation.TEE is a sensitive and specific method for the detection of left atrial thmmbus,especially in left atrial appendage.Accordingly,TEE should be routinely performed in patients with rheumatic mitral valve stenosis and atrial fibrilation,especially for the candidates of interventional or electral defibrilation therapies.