经食管超声心动图在风心病二尖瓣狭窄手术方式选择中的应用

Role of Multiplane Transesophageal Echocardiography in Selection of Operation on Rheumatic Mitral Stenosis

目的评价经食管超声心动图(TEE)在风心病二尖瓣狭窄手术方式选择中的应用价值。方法67例风心病二尖瓣狭窄患者术前作经胸超声(TTE)和TEE检查,重点探查左房血栓、左心耳血栓、左房雾影、瓣膜返流和瓣膜病变等情况。结果TTE检查拟行二尖瓣置换术21例,球囊成形术46例。45例球囊成形术者又经TEE检查后,新发现左心耳血栓12例,改二尖瓣置换术;10例二尖瓣轻度返流,TEE证实为中度返流,改二尖瓣置换术。结论TEE在风心病二尖瓣狭窄手术方式选择中有决定性的作用,对左房血栓、左心耳血栓、左房雾影检出及二尖瓣返流的定量判断较准确、可靠。

Object: To investigate the value of mutiplane transesophageal echocardiography for the determination of the operation forms on rheumatic mitral stenosis(RMS).Methods: Sixty-seven cases with RMS were all examined by both transthoracic(TTE)and TEE before operation.These two methods were compared especially for the evaluation of left atrial thrombi, spontaneous echo contrast, valvular regurgitation and valvular lesion.Results: forty-six of the 67 cases were grouped for balloon dilation and the rest for mitral replacement after TTE examination firstly.After TTE examination,12 of the 46 cases initially for balloon dilation were found thrombi in left atrial appendage,and 10 of the 46 cases with moderate mitral regurgitation were misdiagnosed with slight mitral regurgitation.They were changed for mitral replacement.Conclusion:TEE is crucial for the selection of operation on rheumatic mitral stenosis and is superior to TTE especially for the quantity evaluation of mitral regurgitation and thrombus and spontaneous echo contrast in left atrium.