经食管实时三维超声心动图诊断二尖瓣脱垂的临床应用

Clinical application of real-time three-dimensional transesophageal echocardiography in diagnosis of mitral valve prolapse

目的 探讨经食管实时三维超声心动图（real-time three-dimensional transesophageal echocardiography,RT-3D-TEE）在诊断二尖瓣脱垂（mitral valve prolapse,MVP）中的应用价值.方法 选择因MVP伴中度以上反流拟行二尖瓣成形术（mitral valve repair,MVR）的患者20例,术前行RT-3D-TEE检查并应用二尖瓣量化分析（mitral valve qutification,MVQ）软件建立二尖瓣解剖结构模型,对脱垂部位分区定位及判断有无腱索断裂,与手术所见进行对照.RT-3D-TEE和外科手术中二尖瓣的解剖定位均采用Carpentier命名法,将前叶分为A1、A2和A3区,后叶分为P1、P2和P3区.结果 ①RT-3D-TEE可清晰立体显示MVP脱垂部位和腱索断裂,并能分别从左房面及左室面观察;②RT-3D-TEE诊断P2区的灵敏性（100％）、特异性（95.46％）、符合率（95.83％）最好,阳性似然比最大（22.03）,阴性似然比最小（0）;③RT-3D-TEE诊断P1区灵敏性（66.67％）、特异性（83.76％）、符合率（83.33％）较其他病变小区低,阳性似然比最小（4.11）,阴性似然比最大（0.40）;④RT-3D-TEE诊断腱索断裂的灵敏性、特异性、符合率、阳性似然比、阴性似然比分别为100％、91.67％、95.00％、12.00、0.结论 RT-3D-TEE能清晰立体显示二尖瓣病变形态,在诊断MVP部位和腱索断裂方面准确性较好,在MVR中具有重要的临床应用价值.

Objective To evaluate the clinical application value of real-time three-dimensional transesophageal echocardiography （RT-3D-TEE） in diagnosis of mitral valve prolapse（MVP）.Methods Twenty patients with MVP with more than moderate mitral regurgitation referred for mitral valve repair （MVR） were studied.All patients underwent RT-3D-TEE and mitral valve quantification（MVQ） before MVR.The location of scallop lesions and ruptured mitral chordae tendineae for mitral valve were evaluated,and compared with surgical findings.Carpentier＇s nomenclature was applied to the mitral valve anatomic localization either RT-3D-TEE or surgery.There were three anterior leaflet scallops defined as A1,A2 and A3,and three posterior leaflet scallops defined as P1,P2 and P3.Results ① The shape and spatial structure of the scallop lesions and ruptured mitral chordae tendineae of mitral valve were clearly displayed by RT-3D-TEE,also could be observed through left atrium view and left ventricular view.② Compaired with surgical findings,RT-3D-TEE was of high sensitivity （100 ％）,higher specificity （95.46 ％） and crude agreement （95.83％） in the location of P2,the positive likelihood ratio of location of P2 （22.03） was the biggest,the negative likelihood ratio （0） was the smallest.③ RT-3D-TEE had lower sensitivity （66.67％）,specificity （83.76 ％） and crude agreement （83.33 ％） in the diagnosis of location of P1 than other locations,the positive likelihood ratio（4.11） was the smallest,the negative likelihood ratio （0.40） was the biggest.④ The sensitivity,specificity,crude agreement,positive likelihood ratio and negative likelihood ratio of RT-3D-TEE in diagnosis of ruptured mitral chordae tendineae accompanied by MVP were 100％,91.67％,95.00％,12.00,0 respectively.Conclusions RT-3D-TEE could clearly display the three-dimensional structure of the lesions of mitral valve.It was of better accuracy in diagnosis of the location of scallop lesions of mitral valve and the rupture of chordae tendineae,and was of important clinical application value in MVR.