摘要
目的探讨实时三维经食管超声心动图（RT3D-TEE）在感染性心内膜炎（IE）手术中的应用价值。方法回顾性分析我院经临床确诊并进行外科手术治疗的27例感染性心内膜炎病例，所有病例均经病理证实。术中使用RT3D—TEE，观察赘生物发生部位、瓣膜病变程度，有无并发症形成等，并与术前二维经胸超声心动图（2D-TTE）检查结果相比较。结果与手术结果EE较，术中RT3D-TEE判断瓣膜穿孔以及诊断脓肿、腱索断裂、乳头肌断裂的灵敏性、Youden指数均优于2D-TTE。术中RT 3D-TEE判断赘生物的准确率与2D-TTE比较差异有统计学意义（P=0．035）。术中RT 3D-TEE发现2例二尖瓣成形术后二尖瓣中至重度反流，人工瓣瓣周漏2例，1例二尖瓣生物瓣置换术后左室流出道狭窄。结论术中RT 3D-TEE有利于术前进一步了解受累瓣膜及瓣膜外的感染扩散情况，从而制定最佳的手术方案；心脏复跳后可即刻评估手术效果。
Objective To investigate the value of the intraoperative real-time three-dimensional transesophageal echocardiography （RT 3D-TEE） applied in the surgery for patients with the infective endocarditis （IE）. Methods 27 patients who were diagnosed as IE by clinical examination and underwent surgical treatment were analyzed retrospectively,all these cases were proved by pathology. RT 3D-TEE was performed for assessing the invasive valves, the position of vegetation and complications of IE before cardiopulmonary bypass. The echocardiographic results of 2D-TTE and RT 3D-TEE were both compared with the surgical findings. Results RT 3D-TEE was superior to 2D-TTE for identifying valvular perforation,abscess,rupture of chordae tendinea and rupture of papillary muscle since higher sensitivity and Youden index. RT 3D-TEE was more accurate than 2D-TTE for identifying vegetation （ P = 0. 035）. 2 cases still presented moderate to severe mitral regurgitation after valvuloplasty. Perivalvular leakage was detected by intraoperative RT 3D-TEE in 2 cases. Additionally, the presentation of left ventricular outflow stenosis after biological valve replacement of mitral valve was found by intraoperative RT 31-TEE in 1 case.Conclusions Intraoperative RT 3D-TEE is helpful for providing additional diagnostic information before bypass, identifying the strategy for the operation and instantly assessing the effect of the surgery after heart resuscitation.
出处
《中华超声影像学杂志》
CSCD
北大核心
2013年第1期21-24,共4页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
实时三维
超声心动描记术
经食管
心内膜炎
细菌性
Echocardiography, real time three-dimensional
Echocardiography, transesophageal
Endoearditis, bacterial
