经胸超声心动图详细定位二尖瓣脱垂部位在二尖瓣成形术中的应用价值

Evaluation of the accurate location of the mitral valvular prolapse in the mitral valve plasty by transthoracic echocardiography

目的尝试运用经胸二维超声心动图对二尖瓣脱垂的具体部位及病因进行详细区分和准确判断。方法39例二尖瓣脱垂患者,于二尖瓣成形或置换术前进行经胸超声心动图检查,初步判断脱垂瓣叶的准确部位及病因,外科术中直视下诊断。结果根据外科二尖瓣结构修正命名,术前二尖瓣水平短轴观及其衍生的非标准切面诊断出脱垂的局部瓣体44处,共涉及65个分区,15例患者发现断裂的腱索;术中证实分别为51处瓣体、78个分区,20例检出断裂腱索,符合率86%、83%和75%;5例患者脱垂瓣叶及腱索上发现赘生物并均在术中证实。结论经胸二维超声心动图能对大多数二尖瓣脱垂的具体部位及病因作出准确判断。二尖瓣水平短轴观及其衍生的非标准切面具有重要价值。

Objective To evaluate the extent,location and the pathology of deformities by the transthoracic echocardiography accurately in the patients with the mitral valvular prolapse in details. Methods Thirty-nine subjects with mitral valve prolapse were underwent the echocardiographic examination before the mitral valve plasty or the artificial prosthetic valve replacement,then the final diagnosis were identified objectively by surgery in the operation. Results According to the cardiac surgical Duran criterion of the mitral valve structure, 44 prolapsed leaflets related to 65 subdivision structures were found in all of the patients,and chordea rupture were observed in 15 patients by echocardiography pre-operatively, compared with the 51 （86%） prolapsed leaflets related to 78 （83%） subdivision structures and 20 （75%） patients tendon rupture were confirmed with directly visual inspection in the following operation. The vegetations on the prolapsed leaflets in 5 patients were diagnosed by both echocardiography and surgery. Conclusions It is feasible that the extent, location and the pathology of deformities were demonstrated comprehensively by transthoracic echocardiography. The significance of the short axis view of the mitral valvular level as well as the derived non-standard view from it was emphasized in diagnoses.