经食管三维超声心动图在主动脉瓣位感染性心内膜炎中的应用

目的 探讨经食管三维超声心动图（three-dimensional transesophageal echocardiography,3D-TEE）在诊断感染性心内膜炎（infective endocarditis,IE）主动脉瓣病变中的价值.方法 对49例通过经胸超声心动图（transthoracic echocardiography,TTE）与3D-TEE诊断IE主动脉瓣病变患者的超声诊断特点进行分析,以心脏外科术中所见为“金标准”,将超声特点（赘生物、瓣叶穿孔、瓣周脓肿）与手术结果进行对照.结果 3D-TEE对赘生物、瓣叶穿孔、瓣周脓肿诊出的敏感性及特异性均高于TTE,差异有统计学意义（P＜0.05）.对于检测长度＜（4.5±0.7）mm的赘生物,3D-TEE较TTE更加敏感,差异有统计学意义（P＜0.05）.对于检测瓣周脓肿,3D-TEE较TTE更加敏感,差异有统计学意义（P＜0.05）,且容易发现瓣周脓肿早期组织水肿的情况.结论 与TTE相比较,3D-TEE能更准确检测IE主动脉瓣病变,有效评价此类患者瓣周脓肿情况,具有重要的临床应用价值.

Three-dimensional transesophageal echocardiography for aortic valvular lesions in infective endocarditis

Objectives To explore the value of three-dimensional transesophageal echocardiography （3D-TEE） in the diagnosis of aortic valvular lesions in infective endocarditis （IE）.Methods Forty-nine IE patients were included and the characteristics of aortic valve by transthoracic echocardiography （TTE） and 3D-TEE were analyzed.Echocardiographic characteristics （vegetation,leaflet perforation and paravalvular abscess） of the two methods were compared according to the intraoperative findings which were set as the gold standard.Results The sensitivity and specificity of 3D-TEE for vegetation,leaflet perforation and paravalvular abscess were obviously higher than those of TTE （P〈0.05）.For detecting vegetations smaller than （4.5±0.7） mm,and paravalvular abscess,3D-TEE was much more sensitive than TTE （both P〈0.05）,and 3D-TEE was helpful to observe tissue edema at the early stage.Conclusions Compared with TTE,3D-TEE is superior to detect aortic paravalvular abscess,and appears to be a more sensitive approach for the assessment of aortic valvular lesions in patients with IE.