实时三维经食管超声心动图在二尖瓣脱垂合并感染性心内膜炎中的应用

Application of real-time three-dimensional transesophageal echocardiography in mitral valve prolapsed associated with infective endocarditis

目的 评价实时三维经食管超声心动图（RT-3D-TEE）在二尖瓣脱垂合并感染性心内膜炎（IE）中的应用价值.方法 选择二尖瓣脱垂合并IE患者20例,术前行经胸超声心动图（TTE）和RT-3D-TEE检查,分析脱垂部位及表现特征,并与术中所见进行对比.结果 ①RT-3D-TEE与TTE对二尖瓣脱垂的敏感度为90.3％和87.1％,特异度为97.8％和97.8％,阳性预测值为93.3％和93.1％,阴性预测值为96.7％和95.6％,总符合率为95.8％和95％.RT-3D-TEE的各项参数整体均高于TTE.②RT-3D-TEE在诊断二尖瓣赘生物形成、腱索断裂、穿孔方面的敏感度、特异度整体均高于TTE.结论 ①RT-3D-TEE较TTE更能准确定位二尖瓣脱垂的部位.②RT-3D-TEE能准确显示IE的各种表现形式,对术前手术方式的选择有重要指导作用.

Objective To evaluate the clinical value of real-time three-dimensional transesophageal echocardiography in mitral valve prolapse associated with infective endocarditis.Methods 20 patients undergoing mitral valve prolapse combined with IE were selected to undergo transthoracic echocardiography（TTE） and RT-3D-TEE.The prolapse position and performance characteristics were analyzed and intraoperative findings were compared.Results （1）The sensitivity of RT-3D-TEE and TTE in mitral valve prolapse was 90.3% and 87.1%,the specificity was 97.8% and 97.8%,the positive predictive value was 93.3% and 93.1%,the negative predictive value was 96.7% and 95.6%,The total compliance rate was 95.8% and 95%,RT-3D-TEE parameters were higher than TTE.（2）The diagnostic sensitivity and specificity of RT-3D-TEE in mitral valve formation,chordae rupture and perforation were higher than those in TTE.Conclusion （1）RT-3D-TEE is more accurate than TTE in locating the location of mitral valve prolapse.（2）RT-3D-TEE can accurately display the various manifestations of IE,and it is an important guide to the choice of preoperative surgical methods.