RT-3D-TEE诊断二尖瓣瓣膜置换术后PVL的价值分析

Value of RT-3D-TEE for diagnosing PVL after mitral valve replacement

目的探讨实时三维经食管超声心动图(RT-3D-TEE)诊断二尖瓣瓣膜置换术后瓣周漏(paravalvular leak, PVL)的价值。方法采用回顾性方法分析,选取100例二尖瓣瓣膜置换术患者的临床资料,均常规经胸超声心动图(TTE)与RT-3DTEE检查,比较两种检查结果。结果通过RT-3D-TEE检查诊断有67例(67.00%)术后瓣周漏,其中单处52例(77.61%),多处15例(22.39%);人工二尖瓣反流11例(16.42%),伪影1例(1.49%),瓣周漏长度(3.23±0.12)mm,瓣周漏宽度(3.01±0.42)mm。TTE检查诊断有78例(78.00%)术后瓣周漏,其中单处56例(71.79%),多处22例(28.21%);人工二尖瓣反流4例(6.41%),伪影0例,瓣周漏长度(5.67±0.89)mm,瓣周漏宽度(5.04±0.34)mm。与TEE法比较,RT-3D-TEE在诊断单处与多处、人工二尖瓣反流、伪影、PVL长度和宽度方面效能更高(P <0.05)。结论二尖瓣瓣膜置换术后患者实施RT-3D-TEE检查,可快速、准确诊断PVL,为临床诊疗提供参考,值得临床推广应用。

Objective To explore the value of real-time three-dimensional transesophageal echocardiography(RT-3 D-TEE) for diagnosing the paravalvular leak(PVL) after mitral valve replacement. Methods The clinical data of 100 patients to receive mitral valve replacement were retrospectively analyzed. These patients received routine transthoracic ECG(TTE) and T-3 D-TEE. The results of the two examinations were compared. Results 67 cases(67.00%) of post-operative PVL were diagnosed by use of RT-3 D-TEE,including 52 cases(77.61%) with single PVL and 15 cases(22.39%) with multiple PVL; there were 11 cases(16.42%) of artificial mitral regurgitation and one case(1.49%) of artifact. The PVL was(3.23 ±0.12)mm long and(3.01±0.42)mm wide. 78 cases(78.00%)of post-operative PVL were diagnosed by use of TTE, including 56 cases(71.79%) with single PVL and 22 cases(28.21%) with multiple PVL; there were 4 cases(6.41%) of artificial mitral regurgitation and no artifact. The PVL was(5.67 ±0.89)mm long and(5.04 ±0.34)mm wide. RT-3 D-TEE had higher efficacy in the diagnosis of single and multiple PVL, artificial mitral regurgitation,artifact and the length and width of PVL than TEE. Conclusion After the mitral valve replacement, RT-3 D-TEE can be used for rapid and accurate diagnosis of PVL, so as to provide reference for clinical diagnosis; it is worthy of clinical popularization and application.