目的：回顾性分析探讨实时三维经食管超声心动图在初步诊断二尖瓣瓣周漏及引导封堵治疗中的应用价值。方法：选取我院10例进行人工二尖瓣置换术后发生瓣周漏并进行经胸超声心动图及三维经食管超声心动图检查的患者。入选的瓣周漏患者均进行DSA引导下介入封堵或实时三维经食管超声心动图引导下介入封堵。经胸超声心动图及实时三维经食管超声心动图分别在长轴或短轴切面观测二尖瓣瓣周漏的形态、宽度、长径、方位。结果：经胸超声心动图（（4.21±1.39） mm）及三维经食管超声心动图（（4.10±1.33） mm）在瓣周漏宽度测量上差异无统计学意义（P＞0.05）。经胸超声心动图（（4.82±1.70） mm）及实时三维经食管超声心动图（（5.77±1.72） mm）在瓣周漏长度测量上差异有统计学意义（P＜0.05）。在封堵治疗的手术过程中，8例患者进行DSA及经胸超声心动图引导下封堵，2例患者单纯行实时三维经食管超声心动图引导下封堵。手术过程中实时三维经食管超声心动图对于封堵器类型选取、释放位置、开放形态、残余分流评价等方面有重要临床价值。结论：经胸超声心动图对人工二尖瓣瓣周漏进行初筛，实时三维经食管超声心动图对人工二尖瓣瓣周漏封堵进行精确评估，监测封堵器的置入。
Abstract
Objective: To explore application value of real-time three-dimensional transesophageal echocardiography(3D-TEE) in the diagnosis and occlusion of mitral perivalvular leakage. Methods: Ten patients who diagnosed with mitral perivalvular leakage were selected in our hospital to underwent transthoracic echocardiography(TTE) and 3D-TEE. All patients with perivalvular leakage underwent closure guided by DSA or 3D-TEE. The width, length, and position of perivalvular leakage were measured by TTE and TEE. Results: There was no significant difference in the width of perivalvular leakage measured by TEE or TEE(P＞0.05). The length of perivalvular leakage measured by TEE was obviously longer than by TTE(P＜0.05). In the process of occlusion, 8 patients were guided by DSA and TTE, and 2 patients were guided by TEE only. The 3D-TEE is of great value in the selection and release of occlusion umbrella and the evaluation of residual shunt. Conclusions: TTE was used to preliminary screen of mitral perivalvular leakage. 3D TEE was used to accurately evaluate the mitral perivalvular leakage and release of occlusion umbrella.
关键词
二尖瓣 /
心脏瓣膜疾病 /
超声心动描记术
Key words
Mitral valve /
Heart valve diseases /
Echocardiography
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