实时三维经食管超声心动图定位二尖瓣脱垂部位临床应用

目的:分析二尖瓣脱垂的三维经食管超声心动图(RT-3D-TEE)表现,探讨其诊断二尖瓣脱垂的应用价值。方法:选取由于二尖瓣脱垂引起二尖瓣关闭不全,进行二尖瓣修复或置换的患者23例,术前及术后即刻均行RT-3D-TEE检查,分析二尖瓣脱垂的RT-3D-TEE表现特征及脱垂部位,并与术中所见进行对比。RT-3D-TEE成像切面均采用二尖瓣左心房面外科视野观。结果:23例患者术前即刻二尖瓣左心房面外科视野观均显示清楚,观察二尖瓣小叶共138个。术前RT-3D-TEE判断二尖瓣脱垂小叶33个,无脱垂小叶105个,其中腱索断裂17例;发现3例瓣叶赘生物。术中发现二尖瓣脱垂小叶35个,无脱垂小叶103个,其中腱索断裂16例;赘生物3例。RT-3D-TEE诊断二尖瓣脱垂的敏感性为91.4%,特异性为99%,阳性预测值为97.0%,阴性预测值为97.1%,总符合率为97.1%。RT-3D-TEE判断腱索断裂的准确性为99.3%;诊断瓣叶赘生物的准确性为100%。结论:二尖瓣脱垂的RT-3D-TEE表现具有特征性,RT-3D-TEE是诊断二尖瓣脱垂的有效手段,亦可以提供一些额外信息。

Clinical application of localizing the mitral valve prolapse by real-time 3-dimensional transesophageal echocardiography

Objective: The aims of this study were to analyze the features of mitral valve(MV) prolapse on the real-time 3-dimensional transesophageal echocardiography(RT-3D-TEE) and to explore the value of RT-3D-TEE for localizing the mitral valve prolapse.Methods: Twenty-three patients undergoing MV repair or MV replacement for mitral regurgitation(MR) were studied prospectively.Intraoperative RT-3D-TEE examinations were performed.The features and locations of MV prolapse on the RT-3D-TEE were analyzed and compared with the anatomic findings reported by the cardiac surgeons.The surgical view from the left atrium was used when analyzing the RT-3D-TEE features of MV prolapse.Results: The surgical view from the left atrium were clearly demonstrated in all of the 23 patients and 138 segments were studied.Preoperative 33 segments of MV prolapse were diagnosed and 105 segments were normal.Of the MV prolapse,the chordal ruptures were found in 16 patients and the vegetations were found in 3 patients.The sensitivity,specificity,positive predictive value,negative predictive value and the overall accuracy of localizing the MV prolapse for the RT-3D-TEE were 91.4%,99%,97.0%,97.1% and 97.1% respectively.Additionally,the overall accuracy of identifying the ruptured chordae tendineae and vegetations was respectively 99.3% and 100%.Conclusion: RT-3D-TEE is an effective imaging tool for diagnosing MV prolapse and can provide some additional and helpful information.