经食管三维超声在二尖瓣成形术中的应用

Application of three-dimensional transesophageal echocardiography in mitral valve plasty

摘要:

目的 探讨经食管实时三维超声心动图（RT3D-TEE）在二尖瓣成形术中的应用价值。方法 18 例 拟行二尖瓣成形术的二尖瓣脱垂患者，术前及术后即刻均接受RT3D-TEE 检查。术前观察二尖瓣脱垂的三 维特征及小叶区域，与外科术中所见对照；术后即刻评估二尖瓣成形的手术效果，比较手术前后二尖瓣的对合 高度、瓣环周长和反流面积。结果 RT3D-TEE 显示二尖瓣脱垂的三维图像与外科视野所见高度一致，术前诊 断脱垂小叶的敏感性、特异性分别为96.00%、100.00%。18 例患者中有2 例转行二尖瓣置换术，其余16 例 成功完成二尖瓣成形术。RT3D-TEE 观察术后二尖瓣叶及人工瓣环的形态良好，二尖瓣反流程度明显改善。 二尖瓣的对合高度较术前增加，瓣环周长、反流面积较术前减少，差异有统计学意义（t =-13.556，37.789 和 20.847，均P =0.000）。结论 RT3D-TEE 能清晰显示二尖瓣的三维形态，术前准确诊断脱垂小叶及术后即刻评 估手术效果，在二尖瓣成形术中发挥重要的作用。

Abstract:

Objective To explore the value of real-time three-dimensional transesophageal echocardiography (RT3D-TEE) in mitral valve plasty. Methods A total of 18 patients, who underwent mitral valve plasty for mitral valve prolapse, were given RT3D-TEE examination preoperatively and postoperatively. Three-dimensional features and leaflet segments of mitral valve prolapse were observed by preoperative RT3D-TEE, and the results were compared with those found by surgeons intraoperatively. Postoperative RT3D-TEE was performed to assess the effect of mitral valve plasty, and the preoperative and postoperative parameters such as coaptation height, annulus circumference, and regurgitation area of mitral valve were compared. Results RT3D-TEE showed that threedimensional image of mitral valve prolapse was highly consistent with the surgical view. The sensitivity and specificity of diagnosing prolapsed leaflet by RT3D-TEE were 96.00% and 100.00%, respectively. Among the 18 patients, 2 cases were switched to mitral valve replacement, and in the remaining 16 cases mitral valve plasty was successfully completed. Postoperative RT3D-TEE showed that the morphology of mitral valve and prosthetic annulus was good, and the degree of mitral regurgitation decreased significantly. Compared with the parameters of mitral valve obtained by preoperative RT3D-TEE, the coaptation height was significantly increased, and the annulus circumference and regurgitation area were significantly decreased (P < 0.05). Conclusions RT3D-TEE can clearly display three-dimensional morphology of mitral valve, accurately diagnose prolapsed leaflet before operation and evaluate effect of surgery immediately after operation. Therefore RT3D-TEE plays an important role in mitral valve plasty.