经胸超声心动图定位诊断二尖瓣脱垂的临床应用

Clinical use of transthoracic echocardiography in patients with mitral valve prolapse

目的:探讨经胸超声心动图(TTE)在术中二尖瓣脱垂(MVP)定位诊断中的临床应用价值。方法:回顾性分析126例经手术确诊为MVP并行二尖瓣成形术患者,利用术前TTE及术中经食管超声心动图(TEE)分别对二尖瓣复合装置的解剖、功能进行评估,并定位瓣叶脱垂部位,将超声诊断结果分别与外科直视下诊断结果对照,并对TTE和TEE判断脱垂部位的准确性和特异性进行评估。结果:126例成功行二尖瓣成形术治疗的患者中,TTE与TEE在检测有无赘生物、钙化及腱索断裂这3方面的检出率上差异无统计学意义;与外科术中探查结果相比,TTE定位瓣叶脱垂或连枷部位的准确率为89%～98%(Kappa值0.68～0.90),TEE为92%～99%(Kappa值0.77～0.95),二者定位诊断MVP的差异无统计学意义;TTE评估MVP患者重度反流程度为93%,而TEE为95%,手术注水实验判断为96%,3种方法对二尖瓣关闭不全程度的评估差异无统计学意义。结论:术前TTE能准确评估二尖瓣复合装置的解剖结构与功能,并能精确定位MVP部位。

Objective：To evaluate the clinical value of transthoracic echocardiography （TTE） in patients with mitral valve prolapse before operation. Method：One hundred and twenty-six patients who underwent mitral valve repair for mitral valve proplapse were retrospectively reviewed. TTE and transesophageal echocardiography （TEE） were performed in all patients by using standardized imaging views for identifying the location of flail or prolapsed segments and functional analysis of mitral valve prolapse according to Carpentierrs functional classifica- tion. Compared with surgical findings, the accuracy and specificity of TTE and TEE for locating the segments of MVP was indentified. Result： The difference between TTE and TEE to detect vegetations, ruptured chordate, tendihae or annular calcium was not significant. The incremental value of TEE or TTE for the identification of flail or prolapsed segments according to Carpentier classification was not significant. In the group of MVP, agreement with surgical findings for the localization of prolapsed segments by TTE was 89%- 98% （Kappa value 0.68-- 0.90）, by TEE was 92%-99% （Kappa value 0. 77--0. 95）. Before operation, TTE and TEE study indentified that respectively, 93% and 95% of patients had severe mitral regurgitation respectively, while 95% of patients were considered as severe mitral regurgitation during surgical procedure. The difference between TTE, TEE and surgical findings was not significant. Conclusion： TTE can accurately evaluate the function and anatomy of the mitral complex, and precisely positioning the MVP before surgery.