CAJ | 학술논문

目的探讨实时三维经食管超声心动图(RT 3D-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RT 3D-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.结果与手术结果比较,术中RT 3D-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RT3D-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.
목적 탐토실시삼유경식관초성심동도(RT 3D-TEE)재감염성심내막염(IE)수술중적응용개치.방법 회고성분석아원경림상학진병진행외과수술치료적27례감염성심내막염병례,소유병례균경병리증실.술중사용RT 3D-TEE,관찰췌생물발생부위、판막병변정도,유무병발증형성등,병여술전이유경흉초성심동도(2D-TTE)검사결과상비교.결과 여수술결과비교,술중RT 3D-TEE판단판막천공이급진단농종、건색단렬、유두기단렬적령민성、Youden지수균우우2D-TTE.술중RT 3D-TEE판단췌생물적준학솔여2D-TTE비교차이유통계학의의(P=0.035).술중RT 3D-TEE발현2례이첨판성형술후이첨판중지중도반류,인공판판주루2례,1례이첨판생물판치환술후좌실류출도협착.결론 술중RT3D-TEE유리우술전진일보료해수루판막급판막외적감염확산정황,종이제정최가적수술방안；심장복도후가즉각평고수술효과.
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 3D-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.