二尖瓣反流的功能解剖：经食管超声心动图的准确性及对预后的影响

Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography.

作者信息

Enriquez-Sarano M, Freeman W K, Tribouilloy C M, Orszulak T A, Khandheria B K, Seward J B, Bailey K R, Tajik A J

机构信息

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

出版信息

J Am Coll Cardiol. 1999 Oct;34(4):1129-36. doi: 10.1016/s0735-1097(99)00314-9.

DOI:10.1016/s0735-1097(99)00314-9

PMID:10520802

Abstract

OBJECTIVES

This study was performed to determine the accuracy and outcome implications of mitral regurgitant lesions assessed by echocardiography.

BACKGROUND

In patients with mitral regurgitation (MR), valve repair is a major incentive to early surgery and is decided on the basis of the anatomic mitral lesions. These lesions can be observed easily with transesophageal echocardiography (TEE), but the accuracy and implications for outcome and clinical decision-making of these observations are unknown.

METHODS

In 248 consecutive patients operated on for MR, the anatomic lesions diagnosed with TEE were compared with those observed by the surgeon and those seen on 216 transthoracic echocardiographic (TTE) studies, and their relationship to postoperative outcome was determined.

RESULTS

Compared with surgical diagnosis, the accuracy of TEE was high: 99% for cause and mechanism, presence of vegetations and prolapsed or flail segment, and 88% for ruptured chordae. Diagnostic accuracy was higher for TEE than TTE for all end points (p < 0.001), but the difference was of low magnitude (<10%) except for mediocre TTE imaging or flail leaflets (both p < 0.001). The type of mitral lesions identified by TEE (floppy valve, restricted motion, functional lesion) were determinants of valve repairability and postoperative outcome (operative mortality and long-term survival; all p < 0.001) independent of age, gender, ejection fraction and presence of coronary artery disease.

CONCLUSIONS

Transesophageal echocardiography provides a highly accurate anatomic assessment of all types of MR lesions and has incremental diagnostic value if TTE is inconclusive. The functional anatomy of MR defined by TEE is strongly and independently predictive of valve repairability and postoperative outcome. Therefore, the mitral lesions assessed by echocardiography represent essential information for clinical decision making, particularly for the indication of early surgery for MR.

摘要

目的

本研究旨在确定经超声心动图评估的二尖瓣反流病变的准确性及其对预后的影响。

背景

在二尖瓣反流（MR）患者中，瓣膜修复是早期手术的主要诱因，且基于二尖瓣解剖病变来决定是否进行修复。经食管超声心动图（TEE）能够轻易观察到这些病变，但其观察结果的准确性以及对预后和临床决策的影响尚不清楚。

方法

对248例连续接受MR手术的患者，将TEE诊断的解剖病变与外科医生观察到的病变以及216例经胸超声心动图（TTE）检查所见的病变进行比较，并确定它们与术后预后的关系。

结果

与外科诊断相比，TEE的准确性较高：病因和机制、赘生物及脱垂或连枷节段的诊断准确率为99%，腱索断裂的诊断准确率为88%。对于所有观察终点，TEE的诊断准确性均高于TTE（p < 0.001），但除了TTE成像质量一般或存在连枷瓣叶外，差异幅度较小（<10%）（两者p < 0.001）。TEE识别出的二尖瓣病变类型（瓣膜冗长、活动受限、功能性病变）是瓣膜可修复性及术后预后（手术死亡率和长期生存率；所有p < 0.001）的决定因素，且独立于年龄、性别、射血分数和冠状动脉疾病的存在。