Chiang Cheng-Wen, Huang Han-Luen, Ko Yu-Shien
Department of Internal Medicine, Cathay General Hospital, Taipei Medical University, Taiwan.
J Heart Valve Dis. 2007 Nov;16(6):596-601.
Although balloon mitral valvotomy (BMV) can be guided by on-line transesophageal echocardiography (TEE) or intracardiac echocardiography, few reports have been made comparing these methods. The study aim was to compare on-line TEE and on-line intracardiac echocardiography in the guidance of BMV.
Fifty-five consecutive patients with significant mitral stenosis (mitral area < or = 1.5 cm2), but without significant mitral regurgitation (< or = Sellers grade 2) or left atrial cavitary thrombus, underwent BMV. Patients were prospectively randomized to two groups: group A (n = 28) received on-line guidance by multiplane TEE, while group B (n = 27) received on-line guidance by intracardiac echocardiography. Pre-procedural and post-procedural data were compared between these groups.
There were no significant differences in baseline data and procedural outcomes. On-line TEE was found to be of great help for septal puncture, immediate assessment of results, and the prevention and detection of complications. On-line intracardiac echocardiography also aided in septal puncture and was better tolerated by patients, but had less imaging capabilities, was more expensive, required a second venous access, and on occasion interfered with manipulation of the puncture and balloon catheters.
Although both TEE and intracardiac echocardiography were safe and effective for on-line guidance of BMV, TEE provided better imaging capabilities.
尽管经皮球囊二尖瓣成形术（BMV）可在经食管超声心动图（TEE）或心腔内超声心动图的在线引导下进行，但比较这些方法的报道较少。本研究的目的是比较在BMV引导中在线TEE和在线心腔内超声心动图。
连续纳入55例有显著二尖瓣狭窄（二尖瓣面积≤1.5cm²）但无显著二尖瓣反流（≤ Sellers 2级）或左心房腔内血栓的患者，接受BMV治疗。患者被前瞻性随机分为两组：A组（n = 28）接受多平面TEE在线引导，而B组（n = 27）接受心腔内超声心动图在线引导。比较两组术前和术后的数据。
基线数据和手术结果无显著差异。发现在线TEE对房间隔穿刺、结果的即时评估以及并发症的预防和检测有很大帮助。在线心腔内超声心动图也有助于房间隔穿刺，且患者耐受性较好，但成像能力较差，费用更高，需要第二条静脉通路，有时还会干扰穿刺和球囊导管的操作。
尽管TEE和心腔内超声心动图在BMV在线引导中均安全有效，但TEE提供了更好的成像能力。
