CAJ | 학술논문

目的探讨术中实时三维经食管超声心动图(RT-3D TEE)判断二尖瓣病变区域的准确性,以及评价二尖瓣成形术效果的价值.方法 19例因二尖瓣反流(MR)拟接受二尖瓣成形术患者,采集术前、术后RT-3D TEE图像,将术前所见与术中发现进行比较,并在术后即刻评价手术疗效.结果 RT-3DTEE诊断二尖瓣叶病变与术中发现完全相符16例,3例不符合,其中1例术前诊断前叶中间段、后叶中间段脱垂,术中仅发现瓣环扩大,瓣膜黏液退行性变;1例术前诊断后叶后内段脱垂,术中发现后叶中间段及后内段腱索断裂;1例术前提示瓣环扩大,术中发现后叶中间段脱垂.2D TEE诊断二尖瓣病变与术中发现完全相符仅10例,且对二尖瓣脱垂患者难以明确脱垂的确切瓣区和范围.术后即刻观察成形术效果,其中18例RT-3DTEE显示微量至少量二尖瓣反流,1例术后仍为中重度反流,改行二尖瓣置换术,二尖瓣成形术的成功率为94.7%.结论 RT-3D TEE明显提高了二尖瓣反流病因及病变部位定位的诊断准确性,在二尖瓣成形术手术方案制定及疗效的即刻评估方面发挥了非常重要的作用.
목적 탐토술중실시삼유경식관초성심동도(RT-3D TEE)판단이첨판병변구역적준학성,이급평개이첨판성형술효과적개치.방법 19례인이첨판반류(MR)의접수이첨판성형술환자,채집술전、술후RT-3D TEE도상,장술전소견여술중발현진행비교,병재술후즉각평개수술료효.결과 RT-3DTEE진단이첨판협병변여술중발현완전상부16례,3례불부합,기중1례술전진단전협중간단、후협중간단탈수,술중부발현판배확대,판막점액퇴행성변;1례술전진단후협후내단탈수,술중발현후협중간단급후내단건색단렬;1례술전제시판배확대,술중발현후협중간단탈수.2D TEE진단이첨판병변여술중발현완전상부부10례,차대이첨판탈수환자난이명학탈수적학절판구화범위.술후즉각관찰성형술효과,기중18례RT-3DTEE현시미량지소량이첨판반류,1례술후잉위중중도반류,개행이첨판치환술,이첨판성형술적성공솔위94.7%.결론 RT-3D TEE명현제고료이첨판반류병인급병변부위정위적진단준학성,재이첨판성형술수술방안제정급료효적즉각평고방면발휘료비상중요적작용.
Objective To determine the usefulness of real time three-dimensional transesophageal echocardiography(RT-3D TEE) in the preoperative assessment of mitral valve (MV) pathology by comparing images with surgical findings and to evaluate the function of MV postoperatively. Methods Nineteen consecutive adult patients with established diagnosis of mitral regurgitation(MR) scheduled for surgical correction were enrolled. Intraoperative 2D and 3D transesophageal echocardiography(TEE) were performed. All the 3D images were compared with findings obtained from direct surgical inspection. Postoperative RT-3D TEE was performed immediately to evaluate outcomes of mitral annuloplasty. Results Superb 3D-TEE en face views of the MV were obtained in all patients. Correct diagnoses of MV pathology in agreement with the surgical findings were made in 16 of 19 patients (84. 2%), however in the remaining 3 patients, the diagnoses were incorrect despite good image quality. In one, RT-3D TEE diagnosed prolapse of A2 segment and P2 scallop,which was not confirmed at surgery, but MV degeneration and annular dilatation were observed. In another one, RT-3D TEE revealed prolapse of P3 scallop, while at surgery prolapse involved P2 and P3 with ruptured chordae. In the rest one,surgically detected prolapse of P2 was missed by RT-3D TEE. On the other hand with 2D TEE,the diagnoses correlated poorly with surgical findings,only 10 patients were accurately diagnosed (52.6%). In some patients,2D TEE was able to identify the MVP, but it had difficulty in defining the exact location of the prolapsed segment or scallop. The severity of MR decreased significantly after surgery. MV repair was successful in all patients except one(5.1%), in whom moderate to severe MR was still present and MV replacement was conducted subsequently as an alternative.Conclusions RT-3D TEE provides excellent imaging of MV components, including the anterior and posterior leaflets, as well as annulus and subvalvular structures, which can be especially helpful in planning the most appropriate surgery strategy. RT-3D TEE offers exact anatomic characteristics of mitral annuloplasty rings and bands, providing additional information for the evaluation of surgical outcomes.