经食管及经胸超声心动图诊断心源性栓塞性脑梗死的价值

Value of transesophageal echocardiography and transthoracic contrast echocardiography to the diagnosis of cardio-embolic cerebral infarction

目的比较经食管超声心动图和经胸超声心动图在心源性栓塞性脑梗死(cardio-embolic cerebral infarction,CECI)诊断中的价值。方法 57例隐源性脑梗死患者,均行经食管超声心动图和经胸超声心动图检查,比较2种方法对CECI的检出率。结果经胸超声心动图检出CECI 7例(12.3%),其中主动脉粥样硬化斑块2例为高危性CECI,卵圆孔未闭2例、二尖瓣增厚2例、二尖瓣脱垂1例为低危性CECI,未发现房间隔缺损、左心房自发声学影像;经食管超声心动图检出CECI 22例(38.6%),其中主动脉粥样硬化斑块2例为高危性CECI,卵圆孔未闭2例、二尖瓣增厚2例、二尖瓣脱垂7例、房间隔缺损5例、房间隔膨出瘤3例、左心房自发声学影像1例为低危性CECI;经食管超声心动图对CECI的检出率高于经胸超声心动图(P<0.05)。结论与经胸超声心动图比较,经食管超声心动图在CECI诊断中更具优势。

Objective To compare the clinical value of transesophageal echocardiography(TEE)and transthoracic contrast echocardiography(TTE)to the diagnosis of cardio-embolic cerebral infarction(CECI).Methods Fifty-seven patients with CECI underwent TEE and TTE and their detection rates were compared.Results Seven patients(12.3%)were confirmed CECI by TTE,in which aortic plaque(n=2)was the high risk factor for CECI,and patent foramen ovale(n=2),thickened mitral valve(n=2)and mitral valve prolapsed(n=1)were the low risk factors.No atrial septal defect or left atrial spontaneous acoustic image was found by TTE.Twenty-two patients were confirmed CECI by TEE,in which aortic plaque(n=2)was the high risk factor,and patent foramen ovale(n=7),thickened mitral valve(n=2),mitral valve prolapsed(n=2),atrial septal defect(n=5),atrial septal aneurysm(n=3),and left atrial spontaneous acoustic image(n=1)were the low risk factors.The detection rate of TEE was significantly higher than that of TEE(P<0.05).Conclusion TEE is superior to TTE for the diagnosis of CECI.