实时三维经食管超声心动图在二尖瓣置换术后人工瓣膜功能异常诊断中的应用价值

目的探讨实时三维经食管超声心动图(RT-3D-TEE)在二尖瓣置换术后人工瓣膜功能异常诊断中的应用价值。方法回顾性分析92例经胸超声心动图(TTE)初步诊断为疑似二尖瓣人工瓣膜功能异常患者的临床资料,患者均再次接受RT-3D-TEE检查。比较RT-3D-TEE和TTE检查的结果,分析RT-3D-TEE在二尖瓣人工瓣膜置换术后瓣膜功能异常诊断中的作用。结果92例疑似二尖瓣人工瓣膜功能异常的患者中,82例TTE检查怀疑存在瓣周漏;经RT-3D-TEE检查后,存在1处瓣周漏患者38例,2处瓣周漏患者26例,3处瓣周漏3例,共67例患者99处瓣周漏,瓣周漏发生率87.0%(67/77);15例为正常人工瓣膜生理性反流,TTE假阳性率为18.3%(15/82)。另外10例患者中,5例TTE检查怀疑瓣膜狭窄,经RT-3D-TEE确诊并明确病因,其中3例为血管翳,另2例为血栓;2例TTE检查怀疑感染性心内膜炎,未见赘生物,RT-3D-TEE检测到赘生物;3例TTE检查为生物瓣反流,但不能明确病因,RT-3D-TEE诊断为生物瓣退行性改变。结论RT-3D-TEE技术能够快速、明确二尖瓣人工瓣膜术后瓣膜功能异常原因,定位功能异常发生部位,降低假阳性率,提高诊断的准确性,为治疗的时机选择及手段提供重要依据,值得临床应用。

Application value of real-time three-dimensional transesophageal echocardiography in the diagnosis of artificial valve dysfunction after mitral valve replacement

Objective To investigate the application value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in the diagnosis of artificial valve dysfunction after mitral valve replacement.Methods the clinical data of 92 patients with suspected mitral valve prosthesis dysfunction diagnosed by transthoracic echocardiography(TTE)were retrospectively analyzed.All patients underwent RT-3D-TEE examination again.The results of RT-3D-TEE and TTE were compared to analyze the role of RT-3D-TEE in the diagnosis of valve dysfunction after mitral valve replacement.Results Among the 92 patients suspected of mitral prosthetic valve dysfunction,82 cases were suspected of perivalvular leakage by TTE examination.After RT-3D-TEE examination,there were 38 patients with 1 perivalvular leakage,26 patients with 2 perivalvular leakage and 3 patients with 3 perivalvular leakage,with a total of 67 patients and 99 perivalvular leakage,and the incidence of perivalvular leakage was 87.0%(67/77).Fifteen cases were normal physiological regurgitation.The false positive rate of TTE was 18.3%(15/82).Among the other 10 patients,5 patients suspected of valve stenosis by TTE examination,and RT-3D-TEE confirmed the diagnosis and etiology,including pannus in 3 cases and thrombosis in 2 cases.Two cases of suspected infective endocarditis were examined by TTE,no vegetations were found,and vegetations were detected by RT-3D-TEE.Three cases of bioprosthetic regurgitation were detected by TTE,but the etiology was not clear,and RT-3D-TEE diagnosed bioprosthetic valve degeneration.Conclusion RT-3D-TEE technology can quickly identify the causes of valve dysfunction after mitral valve replacement,locate the site of abnormal valve function,reduce the false positive rate,improve the accuracy of diagnosis,and provide an important basis for the timing and means of clinical treatment.It is worthy of clinical application.