经胸和多平面经食道超声心动图定量诊断主动脉瓣狭窄

A Comparative Study of Transthoracic and Multiplane Transesophageal Echocardiography in Quantitative Diagnosis of Aortic Stenosis

为评价多平面经食道超声心动图（ＭＴＥＥ）定量诊断主动脉瓣狭窄（ＡＳ）的可行性和可靠性，在３２例成年ＡＳ患者中应用经胸超声心动图（ＴＴＥ）测量了主动脉瓣的瓣口面积（ＡＶＡ－ＴＴＥ），最大瞬时压差（ＰＰＧ）和平均压差（ＭＰＧ），应用ＭＴＥＥ测量了瓣口面积（ＡＶＡ－ＴＥＥ），并对手术治疗的患者直接测量了其瓣口面积（ＡＶＡ－ＯＰＥ）。结果显示：①ＡＶＡ－ＴＥＥ与ＡＶＡ－ＴＴＥ、ＡＶＡ－ＴＥＥ与ＡＶＡ－ＯＰＥ以及ＡＶＡ－ＴＴＥ与ＡＶＡ－ＯＰＥ间均高度相关（ｒ分别为０．９１、０．９４、０．９１），ＡＶＡ－ＴＴＥ显著高估ＡＶＡ－ＯＰＥ（Ｐ值＜０．０５）；②ＭＴＥＥ对预测重度ＡＳ（ＡＶＡ≤０．７５ｃｍ２）的敏感性和特异性均为１００％；③ＰＰＧ、ＭＰＧ与ＡＶＡ－ＴＴＥ和ＡＶＡ－ＴＥＥ间仅呈中度负相关（ｒ＝－０．７３～－０．７６），而与ＡＶＡ－ＯＶＥ间无相关关系。表明对于ＡＳ的定量诊断，ＭＴＥＥ具有高度的可行性和可靠性，而跨瓣压差存在明显的限制性。

To assess the feasibility and accuracy of multiplane transesophageal echocardiography (MTEE) in quantitative diagnosis of aortic stenosis (AS), 32 adult patients with AS were studied. The peak (PPG) and the mean (MPG) pressure gradients across the aortic valve were measured by transthoracic Doppler echocardiography (TTE), and the aortic valve area (AVA) was determined by TTE using the continuity equation, by planimetry of AVA with MTEE and by direct measurement during operation (OPE). The results showed that: 1. there were high correlations of AVA determined by MTEE and OPE(r=0.94), by MTEE and TTE (r=0.91), and by TTE and OPE (r=0.91). However, TTE consistantly overestimated OPE measurements (P<0.05); 2. both sensitivity and specificity of MTEE in predicting severe AS were 100%; 3. PPG and MPG correlated only negative moderately with AVA measurements (r=-0.73￣-0.76). It is concluded that MTEE provides a highly feasible and accurate technique, while pressure gradient measurements are less reliable for assessing the severity of AS.