经食管超声心动图系统性评估二尖瓣脱垂的价值

The value of transesophageal echocardiography for mitral valve prolapse evaluation

目的探讨经食管超声心动图(TEE)系统性评估二尖瓣脱垂(MVP)的价值。方法选取2017年1月至2019年12月在嘉兴市第一医院接受外科手术治疗的MVP患者28例为研究对象,术前均行二维TEE和实时三维TEE检查。以手术结果为金标准,计算并比较二维与实时三维TEE对MVP瓣叶及受累二尖瓣装置结构改变的诊断符合率、对MVP亚区定位诊断的阳性符合率及假阳性率。结果所有患者均经手术证实为MVP,其中单亚区脱垂21例,复合亚区脱垂(同时出现≥2个亚区脱垂)7例;瓣环扩张24例;腱索断裂16例;合并Barlow综合征2例。实时三维TEE对瓣叶复合亚区脱垂、腱索断裂的诊断符合率明显高于二维TEE(均P<0.05),两者对瓣叶单亚区脱垂、瓣环扩张的诊断符合率比较,差异均无统计学意义(均P>0.05)。实时三维TEE对MVP亚区定位诊断的阳性符合率为93.3%,明显高于二维TEE的71.1%(P<0.05)。实时三维TEE诊断A1、P1、P2、P3等亚区脱垂的假阳性率分别为4.6%、16.7%、12.5%、4.6%,二维TEE诊断A1、P1、P2等亚区脱垂的假阳性率分别为9.1%、16.7%、18.8%。结论实时三维TEE对二尖瓣复合亚区脱垂、腱索断裂的诊断符合率高于二维TEE,且假阳性率并不增加。

Objective To evaluate the diagnostic value of transesophageal echocardiography(TEE)for mitral valve prolapse(MVP).Methods Twenty-eight patients with MVP who had surgical treatment in Jiaxing First Hospital from January 2017 to December 2019 were enrolled in the study.All of them were assessed with two-dimensional transesophageal echocardiography(2D TEE)and real-time three-dimensional transesophageal echocardiography(RT3D TEE)before surgery.Using surgical findings as gold standard,the diagnostic accuracy of RT3D TEE in identifying the pathological leaflets and mitral apparatus changes in MVP was compared with that of 2D TEE,as well as the accuracy and false positive rate in locating the prolapsed leaflets.Results All patients were confirmed as MVP at surgery.Twenty-one patients had single-leaflet prolapse,seven had multi-leaflet prolapse(lesions involving more than two leaflets),twenty-four patients had annular dilatation,sixteen patients had chordal rupture and two with Barlow's disease.The diagnostic accuracy of RT3D TEE in identifying multi-leaflet prolapse and chordal rupture were significantly higher than that of 2D TEE(both P<0.05).There was no statistically significant difference between these two methods in identifying single-leaflet prolapse and annular dilatation(both P>0.05).The accuracy of RT3D TEE in locating involved leaflets of MVP was significantly higher than that of 2D TEE(93.3%vs.71.1%,P<0.05).The false positive rates of RT3D TEE in detecting A1,P1,P2,P3 prolapse were 4.6%,16.7%,12.5%and 4.6%,respectively,while the false positive rates of 2D TEE in detecting A1,P1,P2 prolapse were 9.1%,16.7%and 18.8%,respectively.Conclusion The diagnostic accuracy of RT3D TEE for mitral valve prolapse with multi-leaflet involvement and chordal rupture were higher than that of 2D TEE,and the false positive rates were similar between the two methods.