经食道超声心动图在二尖瓣球囊扩张术前对左心房血栓检出的研究

Detection Rate of Left Atrial Thrombi by Transesophageal Echocardiography Before Percutaneous Balloon Dilatation of Mitral Valves

目的 :探讨经食道超声心动图 (TEE)对风湿性心脏病中重度二尖瓣狭窄 (二尖瓣口面积为 0 92± 0 2 1cm2 )患者左心房和 (或 )左心耳血栓的诊断价值。方法 :2 41例准备经皮二尖瓣球囊扩张的患者术前检查 ,所有病例经胸超声心动图 (TTE)未发现或可疑左心房和(或 )左心耳血栓 ,并至少禁食 4小时后进行TEE。结果 :76 ( 32 % )例经TEE显示左心耳和 (或 )左心房内附壁血栓。以TEE为标准 ,TTE诊断左心耳血栓的敏感性和特异性分别为 2 5 %和 94%。结论 :大多数二尖瓣狭窄病例左心房血栓发生在左心耳内 ,TTE探查左心耳血栓敏感性低 。

Objective: To study the value of transesophageal echocardiography (TEE) for detecting left atrial and (or) left atrial appendage thrombi before percutaneous palloon dilatation in patients with rheumatic mitral stenosis. Methods: Two hundred and fourty-one patients with moderate to severe rheumatic mitral stenosis, in which mitral valve area was 0.92±0.21 cm 2,received transesophageal echocardiography. All patients neither demonstrated nor were suspected of left atrial and(or) left atrial appendage thrombi by transthoracic echocardiography (TTE). Results: Left atrial appendage and(or) left atrial mural thrombi were found in 76 patients (32%)and left atrial appendage thrombi alone in 44(58%). The sensitivity and specifity of TTE for left atrial appendage thrombi were 25% and 94%,respectively. Conclusions: Left atrial thrombi mostly occur within the left atrial appendage in patients with moderate to severe rheumatic mitral stenosis. The sensitivity of TTE for left atrial appendage thrombi is low. TEE offers significant advantages over TTE for the detection of left atrial thrombi, espically the left atrial appendage thrombi.