Cujec B, Welsh R, Aboguddah A, Reeder B
Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon.
Can J Cardiol. 1992 Oct;8(8):829-38.
To compare the sensitivities of Doppler echocardiography and cardiac catheterization in the diagnosis of severe valvular heart disease in patients requiring valve surgery.
Retrospective analysis of Doppler echocardiograms and cardiac catheterizations.
Tertiary referral cardiovascular centre in a university setting.
Sixty-nine patients undergoing valve surgery between July 1988 and July 1990.
The sensitivities of echocardiography and cardiac catheterization were 84 and 87%, respectively (P = 1.0) in 32 patients who underwent aortic valve surgery primarily for severe aortic stenosis; 83 and 67%, respectively (P = 1.0) in six patients with severe aortic regurgitation, and 100 and 85%, respectively (P = 1.0) in seven patients with combined severe aortic stenosis and regurgitation. The sensitivities of echocardiography and cardiac catheterization in 11 patients who underwent mitral valve surgery for severe mitral stenosis were 73 and 91%, respectively (P = 0.6) and 69 and 92%, respectively (P = 0.3) in 13 patients with severe mitral regurgitation. Sensitivities of echocardiography and cardiac catheterization in the diagnosis of severe tricuspid regurgitation in five patients who had tricuspid valve repair were 100 and 80%, respectively (P = 1.0). Two patients with severe aortic stenosis by echocardiography, but not by catheterization, did not undergo aortic valve replacement during valvular surgery; both required aortic valve replacement within two years of initial surgery because of heart failure. Four patients with severe tricuspid regurgitation identified by echocardiography did not have tricuspid repair; three had pulmonary hypertension and these patients had resolution of tricuspid regurgitation on follow-up. One patient with severe tricuspid regurgitation and absence of pulmonary hypertension required reoperation for tricuspid valve repair 10 months after initial operation.
The sensitivity of echocardiography and cardiac catheterization in the detection of severe valvular lesions requiring surgery is similar. Discordant results should be reviewed carefully with knowledge of the inherent pitfalls of both techniques in order to ensure optimal patient outcome.
比较多普勒超声心动图和心导管检查对需要进行瓣膜手术的严重瓣膜性心脏病患者的诊断敏感性。
对多普勒超声心动图和心导管检查进行回顾性分析。
大学附属医院的三级心血管转诊中心。
1988年7月至1990年7月期间接受瓣膜手术的69例患者。
在主要因严重主动脉瓣狭窄接受主动脉瓣手术的32例患者中，超声心动图和心导管检查的敏感性分别为84%和87%（P = 1.0）；在6例严重主动脉瓣反流患者中，分别为83%和67%（P = 1.0）；在7例严重主动脉瓣狭窄合并反流患者中，分别为100%和85%（P = 1.0）。在11例因严重二尖瓣狭窄接受二尖瓣手术的患者中，超声心动图和心导管检查的敏感性分别为73%和91%（P = 0.6），在13例严重二尖瓣反流患者中，分别为69%和92%（P = 0.3）。在5例接受三尖瓣修复的患者中，超声心动图和心导管检查对严重三尖瓣反流的诊断敏感性分别为100%和80%（P = 1.0）。2例经超声心动图诊断为严重主动脉瓣狭窄但心导管检查未诊断出的患者，在瓣膜手术期间未进行主动脉瓣置换；由于心力衰竭，两人在初次手术后两年内均需要进行主动脉瓣置换。4例经超声心动图诊断为严重三尖瓣反流的患者未进行三尖瓣修复；3例患有肺动脉高压，这些患者在随访中三尖瓣反流得到缓解。1例严重三尖瓣反流且无肺动脉高压的患者在初次手术后10个月需要再次手术进行三尖瓣修复。
超声心动图和心导管检查在检测需要手术的严重瓣膜病变方面的敏感性相似。对于不一致的结果，应结合两种技术固有的缺陷进行仔细评估，以确保患者获得最佳治疗效果。
