经食管三维超声心动图对二尖瓣脱垂成形术的临床分析

Clinical analysis of three-dimensional transesophageal echocardiography in valvuloplasty for mitral valve prolapse

目的评价实时三维经食管超声心动图观察二尖瓣脱垂患者成形术术前和术后的二尖瓣三维结构的临床应用价值。方法收集东阳市人民医院45例二尖瓣脱垂患者成形术前和术后的经食管二维超声心动图和实时三维超声心动图图像,以术中探查为标准计算实时三维经食管超声心动图定位诊断二尖瓣脱垂的敏感度、特异度、准确度。结果二维经食管超声心动图诊断二尖瓣脱垂的总体敏感度52%、特异度75%、准确度62%,实时三维经食管超声心动图诊断二尖瓣脱垂的总体敏感度89%(χ2=15.628,P=0.000)、特异度93%(χ2=21.361,P=0.000)、准确度91%(χ2=17.219,P=0.000)。经统计学分析发现,实时三维经食管超声心动图诊断二尖瓣脱垂的总体敏感度、特异度和准确度显著优于二维经食管超声心动图。结论实时三维经食管超声心动图为二尖瓣成形术提供了快速准确的评价方法,明显提高了二尖瓣脱垂病因及病变部位的正确检出率,且能准确定量评价二尖瓣成形术后的效果,是二尖瓣成形术术前和术后的重要监测手段。

Objectlve To evaluate the clinical application value of real-time three-dimensional transesophageal echocar- diography（ RT-3D TEE） in determining the three-dimensional structure of mitral valve before and after the valvuloplasty in patients with mitral valve prolapse. Methods A total of 48 patients with mitral valve prolapse in our hospital under- went Two-dimensional echocardiography（2d-echo） and RT-3D TEE before and after the mitral valvuloplasty. The sensitivity, specificity and accuracy of RT-3D TEE IN THE diagnosis of mitral valve prolapse were evaluated. Results The overall sensitivity,specificity and accuracy of 2d-echo were 44%, 75% and 57%, and of RT-3D TEE were 89% （χ2 = 15. 628, P = 0. 000 ）, 93 % （ χ2 = 21.361, P = 0. 000） and 91% （ χ2 = 17. 219, P = 0. 000）. The statistical analysis showed that RT-3D TEE was better than 2d-echo. Conclusion RT-3D TEE can provide a rapid and accurate evaluation method for the mitral valvuloplasty, improve the diagnostic accuracy of etiology and location, and can accurately and quantitatively evaluate the effect of valvuloplasty, which is an important way of monitoring the three-dimensional structure of mitral valve before and after the valvuloplasty.