经食管二维与实时三维超声结合在风湿性二尖瓣病变成形术中的应用

Combine use of two and three dimensional transesophageal echocardiography in rheumatic mitral valve repair

目的:研究经食管二维与实时三维超声结合在风湿性二尖瓣病变成形术中的作用。方法:26例临床诊断为风湿性二尖瓣病变拟行二尖瓣成形术患者,术前联合应用经食管二维超声与实时三维超声,对二尖瓣功能不全进行分类,详细定位病变部位,测量二尖瓣前后叶厚度、长度及瓣环径。术后即刻评价疗效。结果:术前超声诊断单纯风湿性二尖瓣关闭不全10例(38.5%),单纯二尖瓣狭窄4例(15.4%),二尖瓣关闭不全重度伴狭窄轻度9例(34.6%),二尖瓣关闭不全重度伴狭窄中度3例(11.5%);瓣膜功能不全Ⅱ型4例(15.4%),ⅡAⅢa-P型18例(69.2%),Ⅲa-AⅢa-P型4例(15.4%)。术后即刻超声评价疗效,3例在超声指导下2次成形,其中2例最终选择瓣膜置换术。结论:经食管二维和实时三维超声心动图结合,在风湿性二尖瓣病变成形术前对瓣膜功能不全进行分类诊断,能准确评估二尖瓣叶厚度和长度,指导术式和人工瓣环的选择。术后即刻评价疗效,在风湿性二尖瓣成形术中有重要的应用价值。

Objective：To investigate the use of transesophageal echocardiography（TEE） in rheumatic mitral valve repair.Method：TEE was performed in 26 patients with rheumatic mitral valve disease before mitral valve repair.The length,thickness of mitral leaf,dimension of mitral valve annulusand and the type of mitral valve dysfunction were evaluated by 2D-TEE.The location of disease was analyzed by 3D-TEE.Result：Ten patients（38.5%） with isolated serious mitral valve regurgitation,4 patients（15.4%） with isolated serious mitral stenosis,3 patients（11.5%） with serious mitral valve regurgitation combined morderate stenosis,9 patients（34.6%） with serious mitral valve regurgitation combined mild stenosis were diagnosed by TEE.Mitral valve dysfunction type Ⅱ 4 pets（15.4%）,ⅡAⅢa-P 18 pets（69.2%）,Ⅲa-AⅢa-P 4 pets（15.4%）.After mitral valve repair immediately,TEE evaluated 3 cases with valve repair were failed,2 of them were performed valve replacement.Conclusion：TEE could evaluate the function of mitral valve dysfunction,measure the length thickness of mitral leaf and the dimension of mitral valve annulus,provid adequate valuable information before and after rheumatic mitral valve repair.TEE does play an important role in rheumatic mitral valve repair.