经食管超声心动图在二尖瓣脱垂成形术监测中的临床应用价值

Clinical value of transesophageal echocardiography in monitoring valvuloplasty for mitral valve prolapse

目的评价经食管超声心动图(TEE)在二尖瓣脱垂成形术监测中应用价值。方法选取37例二尖瓣脱垂并二尖瓣关闭不全中度以上实行二尖瓣脱垂成形术患者作为研究对象,所有患者手术中均实施TEE监测。分析TEE对二尖瓣脱垂病变部位的检查结果及术后即刻评价二尖瓣成形术的效果;监测并比较患者手术前后左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)等参数的变化。结果37例患者共42处病变,TEE术中检出二尖瓣病变部位共37处,检出准确率为88.10%。37例患者中30例一次性成形手术成功;4例术中监测反流呈2级,再次行成形术,然后再次行TEE检查,发现二尖瓣反流减轻至≤1级,再次进行成形术,手术成功;3例术中监测反流呈3级,立即实行二尖瓣人工瓣置换术。术前,患者左心房内径、左心室舒张末期内径、左心室射血分数分别为(40.30±10.30)mm、(60.00±10.10)mm、(47.18±10.10)%,术后7 d分别为(36.01±9.15)mm、(55.32±9.22)mm、(50.50±6.95)%,术后3个月分别为(34.50±9.14)mm、(50.22±9.01)mm、(55.50±7.20)%;术后7 d、3个月,患者左心房内径、左心室舒张末期内径均小于术前,左心室射血分数大于术前,差异有统计学意义(P<0.05)。结论TEE对二尖瓣脱垂成形术中探查二尖瓣结构病变部位及术后及时评估二尖瓣成形效果具有重要的临床应用价值。

Objective To evaluate the application value of transesophageal echocardiography(TEE)in monitoring valvuloplasty for mitral valve prolapse.Methods 37 patients with mitral valve prolapse and moderate or severe mitral valve insufficiency underwent mitral valve prolapse valvuloplasty were selected for the study,and all patients were monitored by TEE during surgery.The results of TEE on the site of mitral valve prolapse and the effect of mitral valvuloplasty were analyzed immediately after surgery;the changes of left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)were monitored and compared before and after surgery.Results A total of 42 lesions were found in 37 patients,and 37 mitral valve lesions were examined intraoperatively by TEE,with an accuracy rate of 88.10%.Of the 37 patients,30 cases had successful primary valvuloplasty;4 cases had grade 2 intraoperative regurgitation and underwent a second valvuloplasty,followed by a second TEE,which reduced mitral regurgitation to≤grade 1 and led to a second valvuloplasty,which was successful;3 cases had grade 3 intraoperative regurgitation and underwent immediate mitral prosthetic valve replacement.Before surgery,the left atrial diameter,left ventricular end-diastolic diameter and left ventricular ejection fraction were(40.30±10.30)mm,(60.00±10.10)mm,and(47.18±10.10)%;at 7 d after surgery,those indicators were(36.01±9.15)mm,(55.32±9.22)mm,(50.50±6.95)%;at 3 months after surgery,those indicators were(34.50±9.14)mm,(50.22±9.01)mm,(55.50±7.20)%.At 7 d and 3 months after surgery,the left atrial diameter and left ventricular end-diastolic diameter were smaller than those before surgery,and the left ventricular ejection fraction was greater than that before surgery.All the differences were statistically significant(P<0.05).Conclusion TEE has important clinical application value in detecting mitral valve structural lesions during mitral valve prolapse valvuloplasty and the timely evaluation of the effect of mitral valve valvuloplasty after surgery.